Abstract
Introduction: Vitamin D deficiency is an underdiagnosed and undertreated condition especially among people with HIV (PWH). The role of vitamin D in calcium, phosphate, and bone metabolism is well-established. Recently, there has been an increased interest in the role of vitamin D in cardiovascular disease (CVD). While vitamin D deficiency has been associated with CVD in observational studies in the general population, there are limited data in PWH. We therefore performed an analysis to assess the association of vitamin D and coronary plaque using coronary CT angiography (CCTA). Methods: This study reports on new analyses from a previously performed observational study. Women with HIV and well-matched HIV negative controls without known CVD or renal disease were included in the analysis. Based on the median value of serum vitamin D levels, participants were dichotomized to either the <25 or ≥25 ng/mL group. CCTA was used to quantify coronary atherosclerosis and to assess plaque characteristics. Result: Forty-three women with HIV (mean age 46±8y, 56% African American, mean duration of HIV 15±6 years, 83% undetectable HIV viral load) and 24 HIV negative women (mean age 47±6y, 62% African American) were included. There were no differences in BMI, HbA1c, lipids, Framingham point score, tobacco use, eGFR or in 25-OH vitamin D levels ( 24.6 [17.7, 31.4] vs 20.3 [14.9, 38.7] ng/mL, p=0.31) among women with HIV and HIV negative women. Women with HIV who had low vitamin D (n=22) had significantly higher numbers of segments with any coronary plaque (2.27 ±3.01 vs 0.38 ±0.97, p=0.02) and segments with non-calcified coronary plaque (1.41 ±1.82 vs 0.29±0.64, p=0.03) compared to women with HIV in the high vitamin D group (n=21). After adjusting for traditional CVD risk factors including Framingham point score, BMI, and race, the relationship between low vitamin D and noncalcified plaque remained significant. Among all women, the low vitamin D group had significantly higher triglycerides compared to the high vitamin D group (122 ±80 vs 91±40mg/dL, p=0.049). Conclusion: Our study demonstrates a significant independent relationship between vitamin D status and coronary atherosclerosis in women with HIV. More specifically, lower vitamin D was associated with noncalcified coronary plaque in women with HIV. Further studies are warranted to evaluate the effect of vitamin D repletion on atherosclerosis reduction in people with HIV.