A 57-Year-Old Man with HIV Infection and New-Onset Angina
A 57-year-old man with a history of HIV infection presented with new-onset angina. He reported two episodes of prolonged (>20 minutes) substernal chest discomfort with associated diaphoresis. His only medical history was chronic HIV infection managed with tenofovir/emtricitabine, darunavir, and ritonavir, with stable CD4 counts of approximately 500 cells/mcL and undetectable viral loads (0 copies/mL). His lipids had been well controlled while on HAART therapy since the 1990s. He had no other cardiac risk factors.
His blood pressure was 126/81mmHg, heart rate was 67 beats per minute, and BMI was 38. His physical exam was unremarkable. His cardiac troponin-T was elevated at 0.05 ng/ml (ULN 0.01 ng/ml) and his ECG showed sinus rhythm with 1 mm of horizontal ST segment depression in V3-V5.
He was initiated on medical therapy for NSTE-ACS and coronary angiography was performed which demonstrated the culprit 95% proximal LAD stenosis (Figure 1). Successful percutaneous coronary intervention was performed with 0% residual stenosis and TIMI III flow (Figure 2).
Which of the following patient factors has not been associated with development of symptomatic coronary artery disease?