Key result
Longer telomere length is linked to ~46% lower CAD risk in people with HIV.
Why the study?
It is unknown whether leukocyte telomere length is associated with coronary artery disease events in persons living with HIV after accounting for traditional and HIV-related risk factors.
Is longer leukocyte telomere length associated with a reduced risk of coronary artery disease events in persons living with HIV?
Case-Control (n=1,078)
Yes
Is longer leukocyte telomere length associated with a reduced risk of coronary artery disease events in persons living with HIV?
Longer leukocyte telomere length is independently associated with a lower risk of future coronary artery disease events in persons living with HIV, even after adjusting for traditional and HIV-related risk factors.
Answers are grounded in this paper and cite their sources.
Longer leukocyte telomere length was associated with lower CAD risk in HIV but should not yet change practice; leaves open prospective validation and causal inference.
BACKGROUND: Leukocyte telomere length (TL) shortens with age and is associated with coronary artery disease (CAD) events in the general population. Persons living with human immunodeficiency virus (HIV; PLWH) may have accelerated atherosclerosis and shorter TL than the general population. It is unknown whether TL is associated with CAD in PLWH. METHODS: We measured TL by quantitative polymerase chain reaction (PCR) in white Swiss HIV Cohort Study participants. Cases had a first CAD event during 1 January 2000 to 31 December 2017. We matched 1-3 PLWH controls without CAD events on sex, age, and observation time. We obtained univariable and multivariable odds ratios (OR) for CAD from conditional logistic regression analyses. RESULTS: We included 333 cases (median age 54 years; 14% women; 83% with suppressed HIV RNA) and 745 controls. Median time (interquartile range) of TL measurement was 9.4 (5.9-13.8) years prior to CAD event. Compared to the 1st (shortest) TL quintile, participants in the 5th (longest) TL quintile had univariable and multivariable CAD event OR = 0.56 (95% confidence interval [CI], .35-.91) and OR = 0.54 (95% CI, .31-.96). Multivariable OR for current smoking was 1.93 (95% CI, 1.27-2.92), dyslipidemia OR = 1.92 (95% CI, 1.41-2.63), and for recent abacavir, cumulative lopinavir, indinavir, and darunavir exposure was OR = 1.82 (95% CI, 1.27-2.59), OR = 2.02 (95% CI, 1.34-3.04), OR = 3.42 (95% CI, 2.14-5.45), and OR = 1.66 (95% CI, 1.00-2.74), respectively. The TL-CAD association remained significant when adjusting only for Framingham risk score, when excluding TL outliers, and when adjusting for CMV-seropositivity, HCV-seropositivity, time spent with detectable HIV viremia, and injection drug use. CONCLUSIONS: In PLWH, TL measured >9 years before, is independently associated with CAD events after adjusting for multiple traditional and HIV-related factors.
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Engel et al. (2020) conducted a case-control in Human Immunodeficiency Virus (HIV) and Coronary Artery Disease (n=1,078). Longest telomere length quintile (5th quintile) vs. Shortest telomere length quintile (1st quintile) was evaluated on First coronary artery disease (CAD) event (OR 0.54, 95% CI 0.31-0.96). In persons living with HIV, having a telomere length in the longest quintile measured over 9 years prior was associated with a 46% lower odds of a coronary artery disease event compared to the shortest quintile (OR 0.54).
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