Prediction of future cardiovascular events by Framingham, SCORE and asCVD risk scores is less accurate in HIV‐positive individuals from the HIV‐HEART Study compared with the general population

Abstract

Objectives Cardiovascular diseases (CVDs) occur more often in people living with HIV (PLWH) than in the general population. It has been reported that CVD risk scores developed for the general population underestimate the CVD risk in PLWH. Performances of the Framingham Risk Score (FRS), the Systematic Coronary Risk Evaluation (SCORE) and the atherosclerotic cardiovascular disease (asCVD) risk score in PLWH were compared with the general population to quantify score‐specific differences in risk prediction. Methods HIV‐positive outpatients from the HIV‐HEART (HIVH) study (n = 567) were compared with participants from the population‐based Heinz Nixdorf Recall (HNR) study (n ~ 4440) both recruited from the German Ruhr area. During a follow‐up time of around 5 years, the associations between the FRS and incident CVD and peripheral artery disease (CVD_pAD), SCORE and coronary heart disease (CHD), and asCVD and incident CVD were examined using logistic regression. Score performances were assessed by comparing the areas under the curve (AUCs). Results The mean ages were 52.9 ± 6.7 and 59.1 ± 7.7 years in the HIVH and HNR studies, respectively. There were fewer incident CVD events in the HNR study than in the HIVH study (CVD_pAD: 3.9% vs. 12.1%; CHD: 2.1% vs. 7.8%; CVD: 3.5% vs. 9.9%). Age‐ and sex‐adjusted CVD risk was greater with increasing FRS, SCORE and asCVD in both cohorts, but the scores performed more accurately in the HNR than in HIVH study (AUCs FRS: 0.71 vs. 0.65; SCORE: 0.70 vs. 0.62; asCVD: 0.74 vs. 0.62). Conclusions Associations between risk scores and future CVD were observed in both cohorts, but the score performances were less reliable in PLWH than in the general population.

Profile of cardiovascular disease risk in type 2 diabetes mellitus patients receiving statin therapy: A cross-sectional study

“…This study was conducted based on Strengthening the Reporting of Cohort Studies in Surgery (STROCSS) 2021 Guideline [ 13 ]. Measurement of ASCVD risk score was calculated based on the Framingham score (FRS), of which the calculation was based on ASCVD risk factors including age, TC, HDL, blood pressure (systolic), current smoking, and diabetes [ 14 ]. The measurement results were categorized into 3, namely low risk (<10%), middle risk (11–19%), and high risk (≥20%).…”

Prediction models for cardiovascular disease risk among people living with HIV: A systematic review and meta-analysis

“…Table 1 shows the characteristics of the included studies. Overall, 17 different models were derived from 13 studies (19,20,(30)(31)(32)(33)(34)(35)(36)(37)(38)(39)(40). There were six HIV-specific models, including the D:A:D model ( 2010 Among four development studies, three (20, 33, 34) used backward selection to remove nonsignificant predictors, whereas the other one (32) did not report a specific strategy for variable selection.…”

“…Ten studies (76.9%) (19, 20, 30-32, 36, 37, 40) were considered to have a low risk of bias in the predictor domain, and all the included studies (19,20,(30)(31)(32)(33)(34)(35)(36)(37)(38)(39)(40) were considered to have a low risk of bias in the outcome domain. The risk of bias related to the participant domain was high in seven studies (53.8%) (30,(33)(34)(35)(38)(39)(40), mainly because they excluded participants with missing data. Twelve studies were judged to have high risk of bias in the analysis domain (19,20,(30)(31)(32)(33)(35)(36)(37)(38)(39)(40).…”

“…The risk of bias related to the participant domain was high in seven studies (53.8%) (30,(33)(34)(35)(38)(39)(40), mainly because they excluded participants with missing data. Twelve studies were judged to have high risk of bias in the analysis domain (19,20,(30)(31)(32)(33)(35)(36)(37)(38)(39)(40). Nine studies ignored or dealt with model overfitting in an inappropriate manner (18, [30][31][32][35][36][37][38][39].…”

The power and wisdom of prevention. Cardiovascular risk, new challenge, and approach to PLWH

“…Associations between risk scores and future CVD were observed in both cohorts, but the score performances were less reliable in PLWH than in the general population. 29 Depending on the population to be studied and until a new CVD risk assessment tool has been derived and validated in the HIV population, we are left to apply and choose between FRS, or the newer ASCVD risk score to HIV-infected patients 30 or the D:A:D cardiovascular disease risk score that has recently been updated to facilitate use in everyday clinical practice (Table 2). 31…”