Background In Switzerland, two distinct algorithms are recommended for cardiovascular prevention: (a) Arbeitsgruppe Lipide und Atherosklerose (AGLA); and (b) European Society of Cardiology (ESC). We validated and determined which algorithm better predicts incident atherosclerotic cardiovascular disease and assessed statin eligibility in Switzerland. Design A prospective population-based cohort. Methods We employed longitudinal data of the CoLaus study involving 6733 individuals, aged 35–75 years, with a 10-year follow-up. Using discrimination and calibration, we evaluated the predictive performance of the AGLA and ESC algorithms for the prediction of atherosclerotic cardiovascular disease. Results From the 6733 initial participants, 5529 were analysed with complete baseline and follow-up data. Mean age (SD) was 52.4 (10.6) years and 54% were women. During an average follow-up (SD) of 10.2 years (1.7), 370 (6.7%) participants developed an incident atherosclerotic cardiovascular disease. The sensitivity of AGLA and ESC algorithms to predict atherosclerotic cardiovascular disease was 51.6% (95% confidence interval (CI) 46.4–56.8) and 58.6% (53.4–63.7), respectively. Discrimination and calibration were similar between the AGLA and ESC algorithms, with area under the receiver operating characteristic curve values of 0.78 (95% CI 0.76–0.80) and 0.79 (0.76–0.81), and Brier scores of 0.059 and 0.041, respectively. Among 370 individuals developing incident atherosclerotic cardiovascular disease, only 278 (75%) were eligible for statin therapy at baseline, including 210 (57%) according to both algorithms, 4 (1%) to AGLA only and 64 (17%) to ESC only. Conclusion AGLA and ESC algorithms presented similar accuracy to predict atherosclerotic cardiovascular disease in Switzerland. A quarter of adults developing atherosclerotic cardiovascular disease were not identified by preventive algorithms to be eligible for statin therapy.
Aims We prospectively assessed and compared the accuracy of cardiovascular risk scores in people living with HIV (PLWH) and individuals from the general population. Methods and results The Systematic Coronary Risk Evaluation Score 2 (SCORE2), the Pooled Cohort Equations (PCE), and the HIV-specific Data Collection on Adverse events of Anti-HIV Drugs (D:A:D) score were calculated in participants free from atherosclerotic cardiovascular disease (ASCVD) between 2003 and 2009. In total, 6373 [mean age, 40.6 years (SD, 9.9)] PLWH from the Swiss HIV Cohort Study (SHCS) and 5403 [52.8 years (SD, 10.7)] individuals from the CoLaus|PsyCoLaus study were eligible for analysis. We tested discrimination and calibration, and the value of adding HIV-specific factors to scores using the net reclassification improvement (NRI). During mean follow-ups of 13.5 (SD, 4.1) in SHCS and 9.9 (SD, 2.3) years in CoLaus|PsyCoLaus study, 533 (8.4%) and 374 (6.9%) people developed an incident ASCVD, respectively. This translated into age-adjusted incidence rates of 12.9 and 7.5 per 1000 person-year, respectively. In SHCS, SCORE2, PCE, and D:A:D presented comparable discriminative capacities [area under the receiver operating characteristic curve of 0.745 (95% confidence interval, CI, 0.723–0.767), 0.757 (95% CI, 0.736–0.777), and 0.763 (95% CI, 0.743–0.783)]. Adding HIV-specific variables (CD4 nadir and abacavir exposure) to SCORE2 and PCE resulted in an NRI of −0.1% (95% CI, −1.24 to 1, P = 0.83) and of 2.7% (95% CI, 0.3–5.1, P = 0.03), respectively. Conclusions PLWH present a two-fold higher rate of incident ASCVD compared to individuals from the general population. SCORE2 and PCE, which are clinically easier to use (reduced set of variables without adding HIV-specific factors), are valid to predict ASCVD in PLWH.
Background Effective cardiovascular preventive strategies are crucial among people living with HIV (PLWH), who are facing a high burden of atherosclerotic cardiovascular disease (ASCVD). However, it remains unclear which cardiovascular risk score is the most appropriate in clinical practice. Purpose We aimed to prospectively assess and compare the accuracy of widely used cardiovascular risk scores in PLWH and individuals from the general population. Methods We used data from the Swiss HIV Cohort Study (SHCS), a longitudinal study involving 20,802 HIV-infected adults aged over 18 years, and from the CoLaus|PsyCoLaus study, a Swiss population-based cohort including 6,733 individuals aged 35–75 years. The European Systematic Coronary Risk Evaluation Score (SCORE), the North American Pooled Cohort Equation (PCE) and the HIV-specific Data Collection o-n Adverse events of Anti-HIV Drugs (D:A:D) score were calculated for all participants free from ASCVD between January 1, 2003 and December 31, 2009. Accuracy of the scores was assessed based on discrimination and calibration metrics for each cohort separately using incident ASCVD as outcome. The value of adding HIV-specific factors to the model presenting the best predictive capacities between SCORE and PCE was evaluated using the net reclassification index (NRI). Results 6,373 PLWH (28.4% women; aged 40.6 [SD, 9.9]; 57.2% on antiretroviral therapy) and 5,403 individuals from the general population (53.5% women, aged 52.8 [SD, 10.7]) were included in the analysis with a mean follow-up time of 13.5 (SD, 4.1) and 9.9 (SD, 2.3) years, respectively. 533 (8.4%) participants in the SHCS and 374 (6.9%) in the CoLaus|PsyCoLaus study experienced an incident ASCVD translating into age-adjusted incidence rates of 12.9 vs. 7.5 per 1,000 person-year, respectively. In SHCS, PCE and D:A:D presented discriminative capacities with AUROC of 0.757 (95% CI, 0.736–0.777) and 0.763 (95% CI, 0.743–0.783), respectively, compared to SCORE (0.704 [95% CI, 0.681–0.728]). Calibration of all scores was suboptimal in SHCS, with under-prediction of ASCVD in the higher deciles of risk compared to the CoLaus|PsyCoLaus study. Adding CD4 nadir (<200 cells/mm3) and abacavir exposure as categorical variables to PCE resulted in a marginal improvement in discrimination and in a global NRI of 2.7% (95% CI, 0.3–5.1, p-value = 0.03). Conclusions PLWH presented a two-fold higher rate of incident ASCVD compared to individuals of the same age from the general population. The accuracy of PCE score to predict ASCVD in PLWH is equivalent to the D:A:D score and may represent a better alternative due to its reduced set of variables and its widespread use. Adding HIV-specific factors to PCE did not improve its predictive performance. FUNDunding Acknowledgement Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Swiss National Science Foundation
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