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VIDEO: Women living with HIV have more myocardial steatosis, reduced diastolic function


 

REPORTING FROM ENDO 2018

– 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.

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Intramyocardial triglyceride content was 0.49% (95% confidence interval, 0.39-2.09) among the women with HIV. 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.

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