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CARDIOVASCULAR JOURNAL OF AFRICA • Volume 31, No 2, March/April 2020
60
AFRICA
in the HIV+/ACS group was a young patient with STEMI
involving the left anterior descending artery, which was the most
common artery involved (60%), followed by the right coronary
artery (35%) and the left circumflex artery (20%).
Risk factors in the HIV+/ACS group included smoking in
11 (55%), hypertension in six (30%), diabetes in two (10%),
dyslipidaemia in two (10%), and one (5%) patient had a family
history of IHD (Fig. 1). The prevalence of diabetes and
dyslipidaemia was higher in the HIV-/ACS group compared
to the HIV+/ACS and the HIV+/no ACS groups (
p
=
0.0006
and 0.0002, respectively). The prevalence of smoking and
hypertension was lower in the HIV+/no ACS group compared to
the other HIV+/ACS and the HIV-/ACS groups (
p
=
0.0012 and
0.0006, respectively) (Fig. 1). Low-density lipoprotein (LDL)
levels were no different in ACS patients whether they were HIV
positive or negative. HIV-positive patients without ACS had
significantly lower LDL levels.
Endothelial function was measured using FMD in all three
groups. The median percentage difference in FMD between
baseline (before blood pressure cuff inflation) and post blood
pressure cuff deflation was significantly higher for the HIV+/
no ACS group (14.3; IQR 6.7–20.6%) compared to the HIV+/
ACS group (5.2; IQR 1.4–13.4%) and the HIV-/ACS group (3.7;
IQR 2.3–4.4%) (
p
=
0.044 and 0.0016, respectively) (Fig. 2).
Table 1. Patient demographics, risk factors and clinical investigations
HIV+/ACS
HIV-/ACS
HIV+/no ACS
p
-value
(
n
=
20)
(
n
=
20)
(
n
=
20)
Age (years)
#
51.1 (8.1)
52.3 (9)
36 (6.8)
< 0.0001
Race (black),
n
(%)
17 (75)
7 (35)
20 (100)
< 0.0001
Male,
n
(%)
13 (65)
16 (80)
10 (50)
0.14
Risk factors,
n
(%)
Smoking
11 (55)
10 (50)
1 (5)
0.0012
Hypertension
6 (30)
7 (35)
0
0.0006
Diabetes
2 (10)
9 (45)
0
0.0006
Dyslipidaemia
2 (10)
10 (50)
0
0.0002
Family history
1 (5)
2 (10)
0
0.31
CIMT
#
(mm)
0.66 (0.16)
0.70 (0.06)
0.50 (0.00)
0.0005
1,3
0.0001
2,3
PWV
#
(m/s)
4.1 (1.1)
4.6 (1.0)
3.6 (0.6)
0.12
Laboratory
Normal values
Haemoglobin
#
(g/dl)
14.3–18.3
12.9 (2.6)
15.0 (1.7)
11.4 (2.1)
0.0086,
1,2
< 0.0001
2,3
Creatinine* (µmol/l)
64–104
74 (65–90)
86 (75–99)
63 (48–71)
0.017,
1,2
0.0003
1,3
Total cholesterol
#
mean (mmol/l)
< 4.5
4.0 (0.9)
5.2 (1.2)
3.1 (0.8)
0.019,
1,3
0.0011
2,3
Triglycerides* (mmol/l)
< 1.7
1.2 (0.95–1.45)
1.3 (0.95–1.95)
1.2 (0.90–1.40)
0.27
HDL
#
(mmol/l)
> 1.0 male
> 1.3 female
1.05 (0.29)
1.03 (0.24)
0.94 (0.27)
0.44
LDL
#
(mmol/l)
< 2.5
2.3 (0.7)
3.5 (1.0)
1.6 (0.6)
0.028,
1,3
< 0.0001
2,3
CD4* (cells/mm
3
)
301 (205–417)
N/A
143 (19–198)
0.0020
#
Mean
±
SD, *median (IQR).
CIMT
=
carotid intima–media thickness, PWV
=
pulse-wave velocity, LDL
=
low-density lipoprotein, HDL
=
high-density lipoprotein, CD4
=
cluster of differentiation.
HIV+/ACS
HIV-/ACS
HIV+/no ACS
% of patients in group
100
75
50
25
0
Smoking
Hypertension
Dyslipidaemia Family history of heart disease
Diabetes
Fig. 1.
Risk-factor profile. There were more smokers but there
were fewer traditional risk factors (hypertension, diabe-
tes, dyslipidaemia and family history of ischaemic
heart disease) in the HIV+/ACS cohort compared to
the HIV-/ACS and HIV+/no ACS cohorts.
HIV+/ACS
HIV-/ACS
HIV+/no ACS
Median change in FMD (%)
30.0
22.5
15.0
7.5
0.0
Baseline to BP cuff inflation
Baseline to nitrate
Fig. 2.
Mean change in FMD post blood pressure cuff
inflation. HIV+/ACS patients had a similar change
from baseline of brachial flow-mediated dilatation
compared to the HIV-/ACS patients (
p
=
0.78). The
HIV+/no ACS group had the most vasoreactivity but
they were significantly younger (
p
=
0.0001).