Comparison of four international cardiovascular disease prediction models and the prevalence of eligibility for lipid lowering therapy in HIV infected patients on antiretroviral therapy

Abstract

AimTo compare four cardiovascular disease (CVD) risk models and to assess the prevalence of eligibility for lipid lowering therapy according to the 2013 American College of Cardiology/American Heart Association (ACC/AHA) guidelines, European AIDS Clinical Society Guidelines (EACS), and European Society of Cardiology and the European Atherosclerosis Society (ESC/EAS) guidelines for CVD prevention in HIV infected patients on antiretroviral therapy.MethodsWe performed a cross-sectional analysis of 254 consecutive HIV infected patients aged 40 to 79 years who received antiretroviral therapy for at least 12 months. The patients were examined at the HIV-treatment centers in Belgrade and Zagreb in the period February-April 2011. We compared the following four CVD risk models: the Framingham risk score (FRS), European Systematic Coronary Risk Evaluation Score (SCORE), the Data Collection on Adverse Effects of Anti-HIV Drugs study (DAD), and the Pooled Cohort Atherosclerotic CVD risk (ASCVD) equations.ResultsThe prevalence of current smoking was 42.9%, hypertension 31.5%, and hypercholesterolemia (>6.2 mmol/L) 35.4%; 33.1% persons were overweight, 11.8% were obese, and 30.3% had metabolic syndrome. A high 5-year DAD CVD risk score (>5%) had substantial agreement with the elevated (≥7.5%) 10-year ASCVD risk equation score (kappa = 0.63). 21.3% persons were eligible for statin therapy according to EACS (95% confidence intervals [CI], 16.3% to 27.4%), 25.6% according to ESC/EAS (95% CI, 20.2% to 31.9%), and 37.9% according to ACC/AHA guidelines (95% CI, 31.6 to 44.6%).ConclusionIn our sample, agreement between the high DAD CVD risk score and other CVD high risk scores was not very good. The ACC/AHA guidelines would recommend statins more often than ESC/EAS and EACS guidelines. Current recommendations on treatment of dyslipidemia should be applied with caution in the HIV infected population.

Cholesterol Screening and Statin Prescription is Low Among HIV-Infected Patients on Protease-Inhibitor Regimens in Botswana

“…This finding is consonant with the lack of measurement of CVD risk factors. The higher proportion with an indication for statin therapy by ASCVD relative to FRS guidelines has also been reported among other HIV patient populations [ 19 , 20 ]. Yet, there was high agreement between ASCVD and FRS in our cohort as has been reported in other small clinical HIV-cohorts [ 21 ].…”

Cardiovascular Disease Risk Prediction in the HIV Outpatient Study

“…Other studies have reported moderate or low concordance in CVD risk score stratification among risk prediction equations [36–38]. The HOPS cohort had a higher prevalence of overweight or obese participants than that reported in other HIV-infected populations to which the risk prediction equations have been applied [18, 19, 37, 38]. The HOPS cohort may have differed from these other populations in additional important ways, including by sociodemographic and insurance status, or healthcare-seeking behaviors that we could not assess.…”

An Exploration the Risk of Cardiovascular Disease in HIV-Positive Persons in Indonesia using Heart Rate Variability

“…A study from the Netherlands reported that around 33% of HIV patients measured by FRS had a high risk of cardiovascular disease (Krikke et al, 2016). This was supported by a cross-sectional study conducted in Croatia (n = 254) reporting that people with HIV had a high risk of CVD, ranging from 27.2% measured by FRS to 51.6% for DAD scores (Begovac et al, 2015). A study from Zimbabwe in HIV-positive people (n = 215, mean age = 39.8-42.0, under ART 3.9 (SD = 3.4)) also reported 1.4% prevalence of high risk cardivascular disease in the next ten years (Zhou et al, 2015).…”