Hypertriglyceridemic waist identifies HIV+ men and women at increased cardiometabolic risk

Background

Screening for increased waist circumference and hypertriglyceridemia (the hypertriglyceridemic-waist phenotype) is an inexpensive approach to identify patients at risk of coronary artery disease in apparently healthy individuals who may be at increased risk of type 2 diabetes and coronary heart disease because of an excess of intra-abdominal (visceral) fat. We examined the relationship between the hypertriglyceridemic-waist and selected cardiometabolic risk factors in HIV individuals.

Methods

The HW phenotype was defined as a waist circumference of 90 cm or more and a triglyceride level of 2.0 mmol/L or more in men, and a waist circumference of 85 cm or more and a triglyceride level of 1.5 mmol/L or more in women. Using these threshold values a total of 2322 patients (841 women and 1481 men) with HIV aged 18-75 years were divided into 4 groups: Low TG/Low WC, High TG/Low WC, Low TG/High WC, High TG/High WC. Continuous variables were analyzed using ANOVA or Kruskal-Wallis test where appropriate; categorical variables were compared using X2-test. The relationship between the HW and cardiometabolic risk assessed with Framingham risk score (FRS) was analyzed using multivariable logistic regression analyses.

Results

Compared with patients who had a waist circumference and triglyceride level below the threshold values, those with the HW phenotype had higher visceral adipose tissue (P<0.001), higher prevalence of hypertension and the metabolic syndrome (P<0.001), higher levels of total and LDL-cholesterol (P<0.001), lower levels of high-density lipoprotein cholesterol (P<0.001), and higher values of HOMA-insulin resistance (P<0.001) as shown in Table 1.

Table 1

The FRS (median 10, range 5;16) was also highest in those with the HW phenotype (P<0.001). These observations were true independent of gender and remained significant after statistical control for illicit drug use, insulin resistance, antiretroviral therapy exposure, leg fat, and proteinuria as shown in image 1. Figure 1

Figure 1

Univariate and multivariable logistic regression anlyses for associated factors with Framingham risk score more than 20%.

Conclusions

Among HIV patients from an Italian monocentric cohort, the HW phenotype was associated with a deteriorated cardiometabolic risk profile and an increased FRS. It is suggested that the simultaneous measurement and interpretation of waist circumference and fasting triglyceride could also be used among HIV patients as an inexpensive tool to identify patients with excess visceral fat and with related cardiometabolic abnormalities.