Development of Appropriate Coronary Heart Disease Risk Prediction Models in HIV-Infected Patients

Mind the gap: difference between Framingham heart age and real age increases with age in HIV-positive individuals–a clinical cohort study

“…Studies in HIV populations have compared the degree of correlation of three traditional risk prediction algorithms, Framingham, Systematic Coronary Risk Evaluation (SCORE) and Prospective Cardiovascular Munster equations 29 30 31. The estimation of relative effects of traditional risk factors on CVD outcomes appears similar between HIV-positive and HIV-negative individuals 32. However, it may be that HIV-specific risk equations that include HIV-specific risk factors may perform better than existing algorithms because of potential differences in aetiology of CVD in the HIV population.…”

Cardiovascular manifestations of HIV infection

“…The most widely used screening tool is the Framingham risk score, which appears to underestimate CHD risk in HIV patients who are smokers 16. HIV specific risk prediction models of CHD have been proposed, and one such tool from the DAD study group incorporated PI exposure with traditional risk factors and appeared to be reasonably accurate in preliminary studies 16…”

HIV-associated vascular diseases: Structural and functional changes, clinical implications

“…Accordingly, coronary heart disease risk prediction models have been developed [4,33,73,143]. The Framingham equation, which was the first utilized [73], accurately predicts coronary events in HIV patients, but it has been reported to underestimate the risk in HIV-infected smokers [33,73,145]. Indeed, a first adaptation of the Framingham scoring equation was suggested by our group within the Pavia Consensus Statements, to more reliably take into account the excessively high prevalence of cigarette smoking in this population and HAART-promoted lipid changes, including duration of exposure to protease inhibitors [73].…”

“…The D:A:D-derived HIV-specific risk equation incorporates now protease inhibitor exposure duration in addition to traditional cardiovascular risk factors. It clearly improves risk scoring in those patients, but remains to be validated in daily practice [4,145]. Facing with these considerations, prevention strategies for vascular diseases in HIV-infected patients have emerged [33,73,146], mainly targeted on traditional cardiovascular risk factors (Table 6).…”