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10th International Workshop on Adverse Drug Reactions and Lipodystrophy in HIV6-8 November 2008, London, UK |
IMPAIRED MYOCARDIAL GLUCOSE METABOLISM IN MEN WITH HIV-ASSOCIATED METABOLIC SYNDROME
Antiviral Therapy 2008; 13(Suppl. 4):A17 (abstract no. O-24)
WT Cade, DN Reeds, P Herrero, S Lassa-Claxton, RJ Gropler, LR Peterson and KE Yarasheski
Washington University School of Medicine, St Louis, MO, USA
OBJECTIVE: To quantify myocardial glucose and fatty acid (FA) metabolism in HIV-positive men with and without the ATP-III-defined metabolic syndrome (MS).
BACKGROUND: Whole-body abnormalities in glucose and FA metabolism and risk of myocardial ischaemia in HIV- associated MS are established; however, HIV-associated MS effects on myocardial substrate metabolism are unknown.
METHODS: In 18 HIV-positive men with MS (HIV+/MS+, 40 ±7 years) and 13 HIV-positive men without MS (HIV+/MS-, 41 ±6 years) myocardial perfusion (MBF), oxygen consumption (MVO2), glucose extraction fraction (GLUEF), glucose utilization (GLUT), glucose utilization/serum insulin (GLUT/INS), FA extraction fraction (FAEF) and FA oxidation (FAO) were quantified using 11C- and 17O-tracers and positron emission tomography (PET) imaging.
RESULTS: As expected, waist circumference (P<0.0001), BMI (P<0.0004) and fasting HOMA (P<0.0001) were greater in HIV+/MS+ than HIV+/MS-. Blood lactate levels were higher in HIV+/MS+ during the PET (P<0.004; Table 1). Whole body insulin resistance (fasting HOMA) predicted lower myocardial GLUEF (r=-0.46, P<0.01) and HDL predicted higher GLUEF (r=0.45, P<0.01) and GLUT/ INS (r=-0.39, P<0.04). Higher blood lactate level during the PET study tended to correlate with lower myocardial GLUEF, (r=-0.35, P<0.10), GLUT/INS (r=-0.37, P<0.08) and lower FAEF (r=-0.36, P<0.10).
| Table 1. (Abstract 0-24) | ||||||||
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| MBF, ml/g/min | MVO2, j/g/min | GLUEF, % | GLUT, nmol/g/min | GLUT/INS, nmol/g/min/µU | FAEF, % | FAO, nmol/g/min | FAUT, nmol/g/min | |
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| HIV+/MS+ | 1.01 ±0.35 | 4.3 ±1.1 | 2.6 ±1.5 | 132 ±76 | 16 ±21 | 37 ±6 | 101 ±35 | 129 ±38 |
| HIV+/MS- | 0.93 ±0.28 | 3.9 ±1.1 | 4.4 ±3.2 | 176 ±134 | 51 ±48 | 51 ±20 | 117 ±50 | 150 ±59 |
| P-value | NS | 0.19 | 0.02 | 0.13 | 0.01 | 0.01 | 0.31 | 0.23 |
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| FAEF, fatty acid extraction fraction; FAO, fatty acid oxidization; GLUEF, glucose extraction fraction; GLUT, glucose utilization; INS, serum insulin; MBF, myocardial perfusion; MVO2, oxygen consumption. | ||||||||
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CONCLUSIONS: The myocardium in HIV+/MS+ appears insulin resistant compared with HIV+/MS-. FA extraction and metabolism were also impaired in HIV+/MS+. These findings imply greater myocardial lactate use in HIV+/MS+, but this requires further study. In HIV+/MS+, the heart’s ability to adapt to conditions requiring increased glucose or FA metabolism could be impaired.
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2008-11-06
O-24
Copyright © 2008 - International Medical Press Ltd. Reproduction of this abstract (other than one copy for personal reference) must be cleared through the Medical Editor, International Medical Press, 36 St Mary-at-Hill, London EC3R 8DU, United Kingdom.