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CHICAGO – Median intramyocardial triglyceride content was nearly four times higher in a group of middle-age women living with HIV, compared with peers without the infection, according to a recent study that also found an association between high myocardial lipids and lower diastolic function.
The video associated with this article is no longer available on this site. Please view all of our videos on the MDedge YouTube channel
For women without HIV, the value was 0.13% (95% CI, 0.11-0.23; P = .004). Further, left atrial passive ejection fraction was significantly lower among women living with HIV, compared with those without HIV (28% vs. 38%, P = .02), said Mabel Toribio, MD, speaking at the annual meeting of the Endocrine Society.
“Probably the most important aspect is that we found an inverse relationship between the intramyocardial triglyceride content and the diastolic function; the higher the intracardiac lipid content of the women living with HIV, the worse their cardiac function,” Dr. Toribio said in an interview. She and her colleagues at Massachusetts General Hospital, Boston, where she is a clinical investigator, found a Spearman’s rank coefficient of –0.51 for the correlation (P = .03)
“The reason that this is important is that individuals with HIV do have an increased risk of heart failure,” said Dr. Toribio. People living with HIV have a hazard ratio for heart failure that ranges from about 1.2 to 1.7, she said.
For women living with HIV with heart failure, about 70% have heart failure with preserved ejection fraction (HFpEF), which is associated with diastolic dysfunction. “In women with HIV, this has been relatively understudied, and one of the mechanisms we were looking into is myocardial steatosis, where we have increased intramyocardial lipid content,” said Dr. Toribio.
“I think, certainly, our work has a lot of clinical implications,” said Dr. Toribio, noting that there are no therapies that improve survival after a diagnosis of HFpEF. In a population with increased rates of diastolic dysfunction, “It’s imperative that we understand the mechanism of this disease process in women living with HIV,” she said.
Intramyocardial lipid content was a reasonable line of inquiry, since it’s known that people living with HIV have increased deposition of fat in various organ systems, including the liver, skeletal muscle, and the heart, said Dr. Toribio. Both HIV and antiretroviral therapy can contribute to ectopic fat deposition, she said.
Women with (n = 18) and without (n = 6) HIV were matched according to age, body mass index (BMI), history of hypertension, and smoking status, said Dr. Toribio. For women with HIV, they had to be on stable antiretroviral therapy for at least 3 months and have no interruption in therapy greater than 2 weeks over the 3 months preceding enrollment.
The study excluded women who had known preexisting heart failure, diabetes, or atherosclerotic cardiovascular disease. Participants also could not be taking lipid-lowering agents or anti-inflammatory medications.
Participants were about 52 years old on average, and had a mean BMI of a little over 30 kg/m2. Lipid values did not differ significantly between groups, except that triglycerides were a mean 107 mg/dL in women living with HIV, compared with 69 mg/dL for women without HIV (P = .01).
Of the women living with HIV, 7/18 (38.5%) were white, the same number were black, and 2 were Hispanic. Three of six women without HIV were white, two were black, and one was Hispanic; racial and ethnic differences between the groups were not statistically significant overall.
Magnetic resonance spectroscopy was used to assess intramyocardial triglyceride levels, measured at the interventricular septum, a region where there’s little overlying pericardial fat.
“We found that the women living with HIV have an increased intramyocardial triglyceride content compared to women without HIV. And notably, we sought to see if there was any relationship between circulating triglyceride levels or body mass index, and there actually was no relationship between intramyocardial triglyceride content and these factors,” said Dr. Toribio in a video interview.
Next steps include two studies, said Dr. Toribio. The first is investigating whether statin therapy improves myocardial steatosis and heart function over time in women living with HIV. The second, involving the same population, is a pilot study to see if growth hormone releasing hormone – which is known to lessen visceral adiposity in people living with HIV – can reduce intramyocardial steatosis and boost cardiac function, she said.
Dr. Toribio reported no financial disclosures. The study was supported by funding from the National Institutes of Health.
SOURCE: Toribio M et al. ENDO 2018, Abstract OR11-2.
CHICAGO – Median intramyocardial triglyceride content was nearly four times higher in a group of middle-age women living with HIV, compared with peers without the infection, according to a recent study that also found an association between high myocardial lipids and lower diastolic function.
The video associated with this article is no longer available on this site. Please view all of our videos on the MDedge YouTube channel
For women without HIV, the value was 0.13% (95% CI, 0.11-0.23; P = .004). Further, left atrial passive ejection fraction was significantly lower among women living with HIV, compared with those without HIV (28% vs. 38%, P = .02), said Mabel Toribio, MD, speaking at the annual meeting of the Endocrine Society.
“Probably the most important aspect is that we found an inverse relationship between the intramyocardial triglyceride content and the diastolic function; the higher the intracardiac lipid content of the women living with HIV, the worse their cardiac function,” Dr. Toribio said in an interview. She and her colleagues at Massachusetts General Hospital, Boston, where she is a clinical investigator, found a Spearman’s rank coefficient of –0.51 for the correlation (P = .03)
“The reason that this is important is that individuals with HIV do have an increased risk of heart failure,” said Dr. Toribio. People living with HIV have a hazard ratio for heart failure that ranges from about 1.2 to 1.7, she said.
For women living with HIV with heart failure, about 70% have heart failure with preserved ejection fraction (HFpEF), which is associated with diastolic dysfunction. “In women with HIV, this has been relatively understudied, and one of the mechanisms we were looking into is myocardial steatosis, where we have increased intramyocardial lipid content,” said Dr. Toribio.
“I think, certainly, our work has a lot of clinical implications,” said Dr. Toribio, noting that there are no therapies that improve survival after a diagnosis of HFpEF. In a population with increased rates of diastolic dysfunction, “It’s imperative that we understand the mechanism of this disease process in women living with HIV,” she said.
Intramyocardial lipid content was a reasonable line of inquiry, since it’s known that people living with HIV have increased deposition of fat in various organ systems, including the liver, skeletal muscle, and the heart, said Dr. Toribio. Both HIV and antiretroviral therapy can contribute to ectopic fat deposition, she said.
Women with (n = 18) and without (n = 6) HIV were matched according to age, body mass index (BMI), history of hypertension, and smoking status, said Dr. Toribio. For women with HIV, they had to be on stable antiretroviral therapy for at least 3 months and have no interruption in therapy greater than 2 weeks over the 3 months preceding enrollment.
The study excluded women who had known preexisting heart failure, diabetes, or atherosclerotic cardiovascular disease. Participants also could not be taking lipid-lowering agents or anti-inflammatory medications.
Participants were about 52 years old on average, and had a mean BMI of a little over 30 kg/m2. Lipid values did not differ significantly between groups, except that triglycerides were a mean 107 mg/dL in women living with HIV, compared with 69 mg/dL for women without HIV (P = .01).
Of the women living with HIV, 7/18 (38.5%) were white, the same number were black, and 2 were Hispanic. Three of six women without HIV were white, two were black, and one was Hispanic; racial and ethnic differences between the groups were not statistically significant overall.
Magnetic resonance spectroscopy was used to assess intramyocardial triglyceride levels, measured at the interventricular septum, a region where there’s little overlying pericardial fat.
“We found that the women living with HIV have an increased intramyocardial triglyceride content compared to women without HIV. And notably, we sought to see if there was any relationship between circulating triglyceride levels or body mass index, and there actually was no relationship between intramyocardial triglyceride content and these factors,” said Dr. Toribio in a video interview.
Next steps include two studies, said Dr. Toribio. The first is investigating whether statin therapy improves myocardial steatosis and heart function over time in women living with HIV. The second, involving the same population, is a pilot study to see if growth hormone releasing hormone – which is known to lessen visceral adiposity in people living with HIV – can reduce intramyocardial steatosis and boost cardiac function, she said.
Dr. Toribio reported no financial disclosures. The study was supported by funding from the National Institutes of Health.
SOURCE: Toribio M et al. ENDO 2018, Abstract OR11-2.
CHICAGO – Median intramyocardial triglyceride content was nearly four times higher in a group of middle-age women living with HIV, compared with peers without the infection, according to a recent study that also found an association between high myocardial lipids and lower diastolic function.
The video associated with this article is no longer available on this site. Please view all of our videos on the MDedge YouTube channel
For women without HIV, the value was 0.13% (95% CI, 0.11-0.23; P = .004). Further, left atrial passive ejection fraction was significantly lower among women living with HIV, compared with those without HIV (28% vs. 38%, P = .02), said Mabel Toribio, MD, speaking at the annual meeting of the Endocrine Society.
“Probably the most important aspect is that we found an inverse relationship between the intramyocardial triglyceride content and the diastolic function; the higher the intracardiac lipid content of the women living with HIV, the worse their cardiac function,” Dr. Toribio said in an interview. She and her colleagues at Massachusetts General Hospital, Boston, where she is a clinical investigator, found a Spearman’s rank coefficient of –0.51 for the correlation (P = .03)
“The reason that this is important is that individuals with HIV do have an increased risk of heart failure,” said Dr. Toribio. People living with HIV have a hazard ratio for heart failure that ranges from about 1.2 to 1.7, she said.
For women living with HIV with heart failure, about 70% have heart failure with preserved ejection fraction (HFpEF), which is associated with diastolic dysfunction. “In women with HIV, this has been relatively understudied, and one of the mechanisms we were looking into is myocardial steatosis, where we have increased intramyocardial lipid content,” said Dr. Toribio.
“I think, certainly, our work has a lot of clinical implications,” said Dr. Toribio, noting that there are no therapies that improve survival after a diagnosis of HFpEF. In a population with increased rates of diastolic dysfunction, “It’s imperative that we understand the mechanism of this disease process in women living with HIV,” she said.
Intramyocardial lipid content was a reasonable line of inquiry, since it’s known that people living with HIV have increased deposition of fat in various organ systems, including the liver, skeletal muscle, and the heart, said Dr. Toribio. Both HIV and antiretroviral therapy can contribute to ectopic fat deposition, she said.
Women with (n = 18) and without (n = 6) HIV were matched according to age, body mass index (BMI), history of hypertension, and smoking status, said Dr. Toribio. For women with HIV, they had to be on stable antiretroviral therapy for at least 3 months and have no interruption in therapy greater than 2 weeks over the 3 months preceding enrollment.
The study excluded women who had known preexisting heart failure, diabetes, or atherosclerotic cardiovascular disease. Participants also could not be taking lipid-lowering agents or anti-inflammatory medications.
Participants were about 52 years old on average, and had a mean BMI of a little over 30 kg/m2. Lipid values did not differ significantly between groups, except that triglycerides were a mean 107 mg/dL in women living with HIV, compared with 69 mg/dL for women without HIV (P = .01).
Of the women living with HIV, 7/18 (38.5%) were white, the same number were black, and 2 were Hispanic. Three of six women without HIV were white, two were black, and one was Hispanic; racial and ethnic differences between the groups were not statistically significant overall.
Magnetic resonance spectroscopy was used to assess intramyocardial triglyceride levels, measured at the interventricular septum, a region where there’s little overlying pericardial fat.
“We found that the women living with HIV have an increased intramyocardial triglyceride content compared to women without HIV. And notably, we sought to see if there was any relationship between circulating triglyceride levels or body mass index, and there actually was no relationship between intramyocardial triglyceride content and these factors,” said Dr. Toribio in a video interview.
Next steps include two studies, said Dr. Toribio. The first is investigating whether statin therapy improves myocardial steatosis and heart function over time in women living with HIV. The second, involving the same population, is a pilot study to see if growth hormone releasing hormone – which is known to lessen visceral adiposity in people living with HIV – can reduce intramyocardial steatosis and boost cardiac function, she said.
Dr. Toribio reported no financial disclosures. The study was supported by funding from the National Institutes of Health.
SOURCE: Toribio M et al. ENDO 2018, Abstract OR11-2.
REPORTING FROM ENDO 2018
