Abstract 13364: ST2 and GDF-15 are Associated With Structural Heart Disease and Mortality in HIV-Infected Individuals
Background: HIV-infected individuals have a high rate of cardiovascular disease, and traditional factors do not fully identify at-risk patients. We thus studied whether biomarkers of inflammation, cardiac stress and renal function are associated with structural heart disease and overall mortality in ambulatory HIV patients.
Methods: Serum biomarkers (ST2, NT-proBNP, GDF-15, Cystatin C, IL-6, D-Dimer, ultrasensitive Troponin I, hsCRP) and echocardiograms were assessed in 332 HIV patients and 50 controls in 2004-2011. We defined systolic dysfunction as ejection fraction <50% and diastolic dysfunction as ≥ stage 1. Mortality data was obtained through the National Death Index.
Results: HIV patients were a median age of 49 years, 80% male, 34% hypertensive, 59% dyslipidemic and 35% smokers. Of the HIV patients, 68% were treated with antiretroviral medication and had undetectable viral loads. Compared with controls, HIV patients had higher levels of all biomarkers except IL-6 (p<0.05 for all except IL-6, p=0.21). Among HIV patients, 45% had diastolic dysfunction (DD); only ST2 was associated with DD in fully-adjusted analysis (RR=1.43 per doubling, 95%CI 1.06-1.92, p=0.019). Systolic dysfunction was rare in this cohort (5%) and showed no association with the candidate biomarkers. Thirty-three deaths occurred among HIV subjects over a median 5.8 years of follow-up. In fully-adjusted analysis, only ST2 (HR 1.89, 95%CI 1.04-3.44, p=0.036) and GDF-15 (HR 1.35, 95%CI 1.02-1.79, p=0.038) were individually associated with mortality. Using ROC analyses, thresholds exceeding 40 ng/ml for ST2 and 1665 pg/ml for GDF-15 were each predictive of mortality. This association was strengthened when both thresholds were surpassed (see figure).
Conclusion: Among ambulatory HIV patients, ST2 and GDF-15 were associated with mortality risk. ST2 was also associated with diastolic dysfunction. ST2 and GDF-15 may be useful biomarkers of CV risk and overall mortality in HIV infection.
- Cardiovascular disease
- Acquired immunodeficiency syndrome
- Diastolic function
- © 2013 by American Heart Association, Inc.