Cardiovascular disease risk scores’ relationship to subclinical cardiovascular disease among HIV-infected and HIV-uninfected men

Abstract

Objective To study cardiovascular disease risk score utility we 1) compared the association between Framingham Risk Score (FRS)/pooled cohort equation (PCE) categories and coronary artery plaque presence by HIV serostatus and 2) evaluated whether D:A:D risk category more accurately identifies plaque in HIV-infected men. Design Cross-sectional analysis within a substudy of the Multicenter AIDS Cohort Study. Methods Cardiac CT was performed to assess coronary plaque. We evaluated the association of plaque with increasing CVD risk score category, stratified by HIV serostatus, using logistic regression. ROC curves compared the discrimination of the scores for plaque by HIV serostatus. The sensitivity and specificity of the risk scores were compared in HIV-infected men. Results The risk score category—plaque associations were stronger among HIV-uninfected men than HIV-infected men, except for non-calcified plaque. For example, the odds of coronary artery calcium (CAC)>0 were 7.03 (95% CI 4.21, 11.76) times greater among men in the PCE high risk versus low risk category among HIV-uninfected men, compared to just 3.13 (95% CI 2.13, 4.61) times greater among men in the high risk versus low risk category among HIV-infected men. Among HIV-infected men, high risk category by PCE identified the greatest percent of men with plaque/stenosis, but with lower specificity than D:A:D and FRS. The prevalence of CAC>0 among men in the PCE low risk category was 26.5% (HIV-uninfected men) and 36.0% (HIV-infected men). Conclusions FRS and PCE categories associate with plaque burden better in HIV-uninfected men. No risk score delivered both high sensitivity and specificity among HIV-infected men.

Predictive Performance of Cardiovascular Disease Risk Prediction Algorithms in People Living With HIV

“…In contrast, studies which have actually investigated the predictive performance of different algorithms have shown conflicting results 15,[17][18][19][20][21][22][23] . However, these studies were limited by the use of cross-sectional measurements of subclinical CVD endpoints (for which the algorithms were not designed) [24][25][26][27][28] , relatively small sample sizes resulting in a limited number of observed CVD events 17,21,23,25,[27][28][29] , a limited selection of algorithms for comparison [17][18][19][20][21]23,25,29 , and/or by not providing external validation 19,20 .…”

The HIV patient profile in 2013 and 2003: Results from the Greek AMACS cohort

“…For example, FRS calculation was only possible for a subset of the study participants due to the lack of blood pressure measurements or HDL-cholesterol measurements especially in the 2003 sample. The use of FRS, instead of other HIV-specific formulas [ 36 ] to quantify CVD risk has been a subject of debate but some recent studies argue that the Framingham equations may still be preferable [ 37 , 38 ]. Bone mass density measurements were very rare in practice; thus, we were not able to assess rates of osteopenia/osteoporosis and their respective changes over time.…”

Subclinical Atherosclerosis Imaging in People Living with HIV

“…This is of importance because a non-calcified or only partially calcified plaque is more likely to take on morphological features typical of high-risk plaque which is prone to adverse future CV events (e.g., plaque rupture or erosion potentially leading to MI) [97,98]. In addition, coronary artery plaque is predominantly non-calcified in patients <50 years of age [80,99,100]. This point may be particularly relevant to PLWH: as, in Western countries, even though HIV-positive populations are aging, their median age is still relatively low, e.g., 48 years in the Swiss HIV cohort study ( and [101]).…”