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Subclinical Carotid Atherosclerosis Is Related to HIV Infection and Low Adherence to a Mediterranean Diet

The Mediterranean diet is characterized by high consumption of legumes, fruits, vegetables, grains and olive oil, moderate intake of fish, wine and dairy products and a low consumption of red and processed meat, cream and pastries. We conducted a cross-sectional study on the association between consuming a Mediterranean diet on carotid intima media thickness (CIMT) and plaque area in HIV-infected subjects and HIV- uninfected controls between July 2009 and April 2011. We enrolled 131 participants ≥18 years without a history of cardiovascular disease (CVD) who had been treated with antiretroviral therapy for ≥1 year and 131 uninfected controls. We measured CIMT and plaque area using ultrasound broadband high-frequency linear transducer. We considered subclinical atherosclerosis (SA) to be present if a participant had CIMT ≥ 0.9 mm or a visible plaque in carotid arteries. A 14-point food-items questionnaire was used to assess adherence to the Mediterranean diet and the score was dichotomized at the median. We also examined traditional risk factors for SA: age, smoking, gender, family history of CVD, hypertension ; and HIV status. Statistical analysis included the chi- squared test and multivariable logistic regression analysis with SA as the dependent variable. Results: SA was found in 87 (33.2%) of 262 participants. We found low adherence to the Mediterranean diet (score <4) more frequently in uninfected controls (50%) than in HIV-infected individuals (34%) (p=0.006). In participants ≥45 years we found SA more frequently in HIV-infected individuals compared to controls (40 of 71 versus 40 of 100, p=0.035). In the multivariable model low adherence to the Mediterranean diet was significantly associated with SA (OR 2.5, 95% CI 1.2 to 5.0, p=0.010) along with smoking (OR 3.5), hypertension (systolic blood pressure >140 mmHg) (OR 2.8) and male gender (OR 2.4). At the age of 55 years the multivariable model suggested that HIV-infected individuals had 2.3 higher odds (95% CI 1.1 to 4.8) for SA compared to uninfected controls (p=0.031). Conclusions: Low adherence to the Mediterranean diet was an independent predictor of SA, and HIV infection was independently associated with SA in older individuals.

HIV infection ; Atherosclerosis ; Carotid Intima-media Thickness ; Diet ; Mediterranean

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