Prediction of hard cardiovascular events in HIV patients

Raggi, Paolo; Francesco, Davide De; Manicardi, Marcella; Zona, Stefano; Bellasi, Antonio; Stentarelli, Chiara; Carli, Federica; Beghetto, Barbara; Mussini, Cristina; Malagoli, Andrea; Guaraldi, Giovanni

doi:10.1093/jac/dkw346

Cited by 22 publications

(37 citation statements)

References 15 publications

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“…Other groups very recently investigated the predictive value of Framingham risk score in longitudinal cohorts and reported moderate discrimination ability. Raggi et al [14] from Modena HIV Metabolic Clinic showed a moderate sensitivity (69%) and specificity (72%) of Framingham model and a better prediction of atherosclerotic cardiovascular disease (ASCVD) by pooled cohort equation (PCE) algorithm proposed by American Heart Association [15]. However, the CV event rate in Modena cohort (4/1000 patient-years) was lower compared with our data and could be hypothetically related to a more accurate adherence to preventive CV measure in this HIV Metabolic Clinic.…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2017

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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.

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Section: Discussionmentioning

confidence: 99%

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

et al. 2017

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“…To date, many studies have focused on the agreement between predicted risks provided by different algorithms, which varied from poor to excellent [13][14][15][16] , and does not reflect their predictive ability. In contrast, studies which have actually investigated the predictive performance of different algorithms have shown conflicting results 15,[17][18][19][20][21][22][23] . However, these studies were limited by the use of cross-sectional measurements of subclinical CVD endpoints (for which the algorithms were not designed) [24][25][26][27][28] , relatively small sample sizes resulting in a limited number of observed CVD events 17,21,23,25,[27][28][29] , a limited selection of algorithms for comparison [17][18][19][20][21]23,25,29 , and/or by not providing external validation 19,20 .…”

Section: Introductionmentioning

confidence: 99%

Predictive Performance of Cardiovascular Disease Risk Prediction Algorithms in People Living With HIV

Zoest

Law

Sabin

et al. 2019

JAIDS Journal of Acquired Immune Deficiency Syndromes

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Sharp & Dohme, Bristol-Myers Squibb, Janssen-Cilag, ViiV HealthCare, and consultancy and presentation fees from Gilead Sciences. Prof. C.A. Sabin has received funding for participation in Advisory Boards, for membership of Data Safety and Monitoring Committees, and for the preparation of educational materials from Gilead Sciences, ViiV Healthcare and Janssen-Cilag. Dr. I. Vaartjes has nothing to disclose.

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“…Other studies have demonstrated good [ 13 ] versus poor [ 14 ] agreement with the well-established Framingham Risk Score (FRS). The FRS has been reported to accurately predict CVD risk [ 10 , 15 ], underestimate CVD risk [ 12 , 14 ] or overestimate risk [ 15 ]. When applied to HIV cohorts, the HIV-specific CVD risk prediction equation from the Data Collection on Adverse Events of Anti-HIV Drugs (D:A:D) cohort has also been noted to both underestimate predicted CVD risk [ 10 , 11 ] and overestimate it [ 15 ] based on expected CVD endpoints.…”

Section: Introductionmentioning

confidence: 99%

Cardiovascular disease risk prediction by the American College of Cardiology (ACC)/American Heart Association (AHA) Atherosclerotic Cardiovascular Disease (ASCVD) risk score among HIV-infected patients in sub-Saharan Africa

et al. 2017

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ObjectivesHIV-infected patients are at increased risk for cardiovascular disease (CVD). However, general population CVD risk prediction equations that identify HIV-infected patients at elevated risk have not been widely assessed in sub-Saharan African (SSA).MethodsHIV-infected adults from 30–50 years of age with documented viral suppression were enrolled into a cross-sectional study in Gaborone, Botswana. Participants were screened for CVD risk factors. Bilateral carotid intima-media thickness (cIMT) was measured and 10-year predicted risk of cardiovascular disease was calculated using the Pooled Cohorts Equation for atherosclerotic CVD (ASCVD) and the 2008 Framingham Risk Score (FRS) (National Cholesterol Education Program III–NCEP III). ASCVD ≥7.5%, FRS ≥10%, and cIMT≥75th percentile were considered elevated risk for CVD. Agreement in classification of participants as high-risk for CVD by cIMT and FRS or ASCVD risk score was assessed using McNemar`s Test. The optimal cIMT cut off-point that matched ASCVD predicted risk of ≥7.5% was assessed using Youden’s J index.ResultsAmong 208 HIV-infected patients (female: 55%, mean age 38 years), 78 (38%) met criteria for ASCVD calculation versus 130 (62%) who did not meet the criteria. ASCVD classified more participants as having elevated CVD risk than FRS (14.1% versus 2.6%, McNemar’s exact test p = 0.01), while also classifying similar proportion of participants as having elevated CVD like cIMT (14.1% versus 19.2%, McNemar’s exact test p = 0.34). Youden’s J calculated the optimal cut point at the 81st percentile for cIMT to correspond to an ASCVD score ≥7.5% (sensitivity = 72.7% and specificity = 88.1% with area under the curve for the receiver operating characteristic [AUC] of 0.82, 95% Mann-Whitney CI: 0.66–0.99).ConclusionWhile the ASCVD risk score classified more patients at elevated CVD risk than FRS, ASCVD score classified similar proportion of patients as high risk when compared with established subclinical atherosclerosis. However, potential CVD risk category misclassification by established equations such as ASCVD may still exist among HIV-infected patients; hence there is still a need for development of a CVD risk prediction equation tailored to HIV-infected patients in SSA.

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Prediction of hard cardiovascular events in HIV patients

Abstract: All algorithms showed a modest predictive ability, although the PE and DAD algorithms identified more patients at low risk.

Cited by 22 publications

References 15 publications

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

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

Predictive Performance of Cardiovascular Disease Risk Prediction Algorithms in People Living With HIV

Cardiovascular disease risk prediction by the American College of Cardiology (ACC)/American Heart Association (AHA) Atherosclerotic Cardiovascular Disease (ASCVD) risk score among HIV-infected patients in sub-Saharan Africa

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