Cardiovascular Risk Assessment: A Comparison of the Framingham, PROCAM, and DAD Equations in HIV-Infected Persons

Abstract

This study aims to estimate the risk of cardiovascular disease (CVD) and to assess the agreement between the Framingham, Framingham with aggravating factors, PROCAM, and DAD equations in HIV-infected patients. A cross-sectional study was conducted in an outpatient centre in Brazil. 294 patients older than 19 years were enrolled. Estimates of 10-year cardiovascular risk were calculated. The agreement between the CVD risk equations was assessed using Cohen's kappa coefficient. The participants' mean age was 36.8 years (SD = 10.3), 76.9% were men, and 66.3% were on antiretroviral therapy. 47.8% of the participants had abdominal obesity, 23.1% were current smokers, 20.0% had hypertension, and 2.0% had diabetes. At least one lipid abnormality was detected in 72.8%, and a low HDL-C level was the most common. The majority were classified as having low risk for CV events. The percentage of patients at high risk ranged from 0.4 to 5.7. The PROCAM score placed the lowest proportion of the patients into a high-risk group, and the Framingham equation with aggravating factors placed the highest proportion of patients into the high-risk group. Data concerning the comparability of different tools are informative for estimating the risk of CVD, but accuracy of the outcome predictions should also be considered.

Cardiovascular risk prediction in HIV‐infected patients: comparing the Framingham, atherosclerotic cardiovascular disease risk score (ASCVD), Systematic Coronary Risk Evaluation for the Netherlands (SCORE‐NL) and Data Collection on Adverse Events of Anti‐HIV Drugs (D:A:D) risk prediction models

“…To our knowledge, this is the largest cross‐sectional analysis that has compared the predictions of CVD risk prediction models in HIV‐infected patients. In addition, this is also the first study to use the FHS general CVD model, instead of the CHD model, which previous studies have used in HIV‐infected populations [21,28,29]. This is important, as FHS‐CHD only focuses on coronary endpoints, while FHS‐CVD incorporates a much broader array of endpoints (Table b), even including transient ischemic attack and peripheral artery disease, diseases also prevalent in HIV‐infected patients.…”

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.…”

Management of lipid disorders in patients living with HIV

“…Elevated TG with low HDL-C is the most common lipid abnormality in HIV-infected patients. 109 The cornerstone of TG treatment remains lifestyle modification and cardiovascular risk reduction through such interventions as weight loss in obese patients, aerobic exercise, avoidance of concentrated sugars, and strict glycemic control in diabetics. For markedly elevated TG (greater than 500 mg/dL), medication is generally indicated as well as lifestyle modification and treatment of possible secondary causes.…”