Observed versus predicted cardiovascular events and all-cause death in HIV infection: a longitudinal cohort study

Abstract

BackgroundThe aim of the study was to assess the applicability of an algorithm predicting 10-year cardiovascular disease (CVD) generated in the setting of the Framingham Heart Study to a real-life, contemporary Italian cohort of HIV-positive subjects.MethodsThe study was an observational longitudinal cohort study. The probability for 10-year CVD events according to the Framingham algorithm was assessed in 369 consecutive HIV-positive participants free from overt CVD enrolled in 2004, who were followed for a median of 10.0 years (interquartile range, 9.1-10.1). Cardiovascular events included myocardial infarction, hospitalized heart failure, revascularized angina, sudden cardiac death, stroke, peripheral arterial disease.ResultsOver 3097 person-years of observation, we observed a total of 34 CVD events, whereas Framingham algorithm predicted the occurrence of 34.3 CVD events. CVD event rate was 11.0/1000 person-years of follow-up. In a receiver operating characteristics curve analysis, Framingham risk equation showed an excellent predictive value for incident CVD events (c-statistics, 0.83; 95% confidence interval, 0.76-0.90). In a multivariable Cox analysis, age, smoking and diabetes were independent predictors of CVD events. All-cause death rate was 20.0/1000 person-years of follow-up (n = 62 deaths). Causes of death included liver diseases (18), malignancies (14), AIDS-related (11); cardiovascular (9) and others (10). In a Cox analysis, age, AIDS diagnosis and chronic hepatitis were independent predictors of death.ConclusionsObserved CVD events in HIV-infected patients were well predicted by Framingham algorithm. Established major CVD risk factors are the strongest determinants of CVD morbidity in an Italian contemporary cohort of HIV-positive subjects. Interventions to modify traditional risk factors are urgently needed in HIV people.

Cardiovascular disease‐related mortality and factors associated with cardiovascular events in the TREAT Asia HIV Observational Database (TAHOD)

“…Those aged ≥ 51 years had 5.5 times the hazard compared with those aged < 40 years. This is consistent with other studies indicating the effect of aging on the increased risk of CVD . Younger median age might also, in combination with prescription of ART regimens that are less detrimental to cardiovascular health, explain the reduced CVD hazard in the group of patients who started ART more recently.…”

Evaluation of Cardiovascular Disease Risk in HIV-1–Infected Patients Treated with Darunavir

“…Consistent with the pooled analysis of Janssen-sponsored clinical trials, higher CVD event reporting rates were observed during the period 2006–2009, when only twice-daily darunavir/ritonavir 600/100 mg was available, compared with the reporting rates for 2010–2016, when both twice-daily darunavir/ritonavir 600/100 mg and once-daily darunavir/ritonavir 800/100 mg were available. Overall, CVD event reporting rates with darunavir were significantly lower than the observed rates of CVD events in the general HIV-1–infected population [ 43 , 44 ]. The data mining analysis of post-marketing pharmacovigilance databases [FAERS (2016 Q2) and VigiBase (2016 Q4)] exhibited disproportionality of CVD events mainly for first-generation PIs (e.g., indinavir, nelfinavir, ritonavir, saquinavir).…”

Sex differences in the contemporary management of HIV patients admitted for acute myocardial infarction

“…There are no prior studies directly examining this in PLHIV. Considering that males and females tend to have similar improvements in cardiovascular events with aggressive secondary prevention strategies in the general population, there is need for further research specific to our patient cohort . We hypothesize that the higher hospital cost in males is due to related difference in invasive vs noninvasive management strategies between males and females in our study.…”

“…HAART may also independently potentiate low‐grade arterial inflammation . This population has a preponderance of traditional risk factors for CVD that strongly predict CVD events in both HIV‐infected and uninfected populations alike . The increased risk of AMI in those infected with HIV has been the subject of multiple cohort studies.…”

“…24 This population has a preponderance of traditional risk factors for CVD that strongly predict CVD events in both HIV-infected and uninfected populations alike. 25,26 The increased risk of AMI in those infected with HIV has been the subject of multiple cohort studies. A meta-analysis of 23 studies demonstrated a relative risk of CVD in PLHIV of 1.52 to 2.00 (depending on treatment status) as compared with seronegative controls.…”