Cardiovascular risk assessment in HIV-infected male patients: a comparison of Framingham, SCORE, PROCAM and DAD risk equations

Abstract

Introduction: Traditional cardiovascular (CVD) risk assessment algorithms such as the Framingham Risk Score (FRS), Systematic Coronary Risk Evaluation (SCORE) and Prospective Cardiovascular Munster (PROCAM) were developed for general populations, their usefulness in HIV-infected population has not been confirmed. DAD algorithm was developed specifically for HIV-infected patients. The aim of our study was to evaluate the performance of risk assessment algorithms in HIV-infected population. Methods: A prospective cross-sectional national study that included 83 HIV-infected male patients from Slovenia below the age of 55 was performed. CVD risk was assessed using four algorithms, the presence of subclinical atherosclerosis was determined by measuring carotid intima-media thickness (CIMT); patients were followed up for 5 years. Results: High proportion of patients with low CVD risk according to FRS (61.9%) and PROCAM (81.0%) and only 7.1% according to SCORE had evidence of subclinical atherosclerosis. Only 7.1% of patients with low CVD risk according to DAD algorithm had evidence of subclinical atherosclerosis. Conclusion: Our study has shown that SCORE and DAD algorithm were superior to FRS and PROCAM. In younger HIV-infected patients, even with moderate CVD risk, CIMT assessment should be employed in a complete clinical evaluation as a more aggressive prevention and treatment approach is warranted.

Cardiovascular risk factors in HIV infected individuals: Comparison with general adult control population in Greece

“…SCORE and FRS have been rarely compared in PLHIV. In a study it was found that SCORE and D:A:D equations were superior to FRS in estimating CVD risk in PLHIV [48]but, in another study conducted in HIV-infected individuals in the USA, it was found that FRS accurately estimated risk of CVD events, D:A:D underestimated risk whereas SCORE performed poorly [49]. However, SCORE equations have been developed and validated in European cohorts and thus they may be more appropriate for using in a European country.…”

Coronary Artery Disease in HIV-Infected Patients: Downside of Living Longer

“…A newly developed score developed for HIV+ patients, the DAD score, has added length of ART treatment and the exposure to certain drugs (abacavir, indinavir, lopinavir) to traditional risk factors. Three studies have compared Framingham risk scores (FRS) to the DAD score [98–100], as well as to the FRS with aggravating factors [99], Systematic Coronary Risk Evaluation (SCORE)[100], and Prospective Cardiovascular Munster (PROCAM) score [99, 100] in HIV-infected individuals. Although results from these studies were inconsistent due to differences in study population characteristics, all three studies found fair to good agreement (range 32.5 to 77.4%) among these scores but mostly low (range −0.045 to 0.533) kappa values.…”

Consumo alimentar e risco cardiovascularem pessoas vivendo com HIV/AIDS

“…O baixo risco de DCV indicado pelo escore de Framingham encontrado em nossa amostra corrobora dados da literatura 35 . O mesmo pode ser justificado pela menor acurácia dos tradicionais escores de risco para DCV em PVHA 36 .…”