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

Zoest, Rosan A van; Law, Matthew; Sabin, Caroline; Vaartjes, Ilonca; Valk, Marc van der; Arends, Joop E.; Reiss, Peter; Wit, Ferdinand W. N. M.

doi:10.1097/qai.0000000000002069

Cited by 29 publications

(43 citation statements)

References 40 publications

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“…When combined with the evidence of elevated prevalence of tachycardia and ST/T abnormalities in HIV infection, and potentially as a result of persistent inflammation, which is a well-known feature of chronic HIV infection, we speculate that HIV-associated tachycardia and ST/T abnormalities may be a good potential marker indicating CVD pathogenesis and increased risk of further CVD events in this population. This is important in developing a CVD risk prediction tool for HIV infection because current prediction tools developed for use in the general population underestimate the risk in HIV infection [15,16].…”

Section: Discussionmentioning

confidence: 99%

“…In our earlier report [12], higher prevalence of subclinical atherosclerosis was observed in HIV-positive vs. HIV-negative individuals, highlighting an emerging CVD risk among the HIV-positive population in this region [12e14]. However, the Framingham risk score underestimates CVD risk in HIV infection, thus emphasizing the need to identify additional markers for improving risk prediction [12,15,16].…”

Section: Introductionmentioning

confidence: 97%

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HIV infection and electrocardiogram abnormalities: baseline assessment from the CHART cohort

Ding

Zhu

Lin³

et al. 2020

Clinical Microbiology and Infection

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Objectives: To investigate the prevalence of various electrocardiogram (ECG) abnormalities among HIVpositive and HIV-negative individuals. Methods: This cross-sectional evaluation included 1412 HIV-positive and 2824 HIV-negative participants aged 18 to 75 years and frequency matched by age and sex, derived from the baseline survey of Comparative HIV and Aging Research in Taizhou (CHART), China, between February and December 2017. Results: HIV-positive individuals had higher prevalence of sinus tachycardia (5.6% (79/1412) vs. 1.3% (36/ 2824), p < 0.001) and ST/T wave abnormalities (14.9% (211/1412) vs. 9.4% (264/1412), p < 0.001) but lower prevalence of sinus bradycardia (4.8% (68/1412) vs. 7.5% (211/2824), p 0.001); such associations remained statistically significant after adjusting for traditional risk factors (respectively, adjusted odds ratio (aOR) 4.68, 95% confidence interval (CI) 3.06e7.17; aOR 1.89, 95% CI 1.54e2.34; aOR 0.60, 95% CI 0.44e0.80). In adjusted models, being in higher carotid intimaemedia thickness categories was significantly associated with ST/T abnormalities in HIV-positive individuals only (0.78e1.00 mm: aOR 1.46, 95% CI 1.01e2.12; >1.00 mm: aOR 2.18, 95% CI 1.39e3.42), whereas being in higher blood pressure categories was significantly associated with both sinus tachycardia (prehypertension: aOR 5.61, 95% CI 1.76e17.91; hypertension: aOR 12.62, 95% CI 3.60e44.27) and ST/T abnormalities (hypertension: aOR 2.04, 95% CI 1.41 e2.95) in HIV-negative individuals only. Longer duration of known HIV infection was the only HIVspecific factor of ST/T abnormalities (aOR 1.61, 95% CI 1.17e2.22), with none for sinus tachycardia. Conclusions: HIV infection is independently associated with sinus tachycardia and ST/T abnormalities. Further research is needed to investigate specific mechanisms by which HIV infection leads to ECG abnormalities and to evaluate whether inclusion of ECG parameters improves cardiovascular disease prediction. Integrating ECG screening into routine HIV care is recommended in China.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 97%

HIV infection and electrocardiogram abnormalities: baseline assessment from the CHART cohort

Ding

Zhu

Lin³

et al. 2020

Clinical Microbiology and Infection

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“…However, this cohort included less than 25% females and only about 10% blacks. Recently several CVD scores, including the Framingham risk score and the D:A:D score, were compared in HIV-infected, and none of the scores turned out to be superior [27]. There is no research so far that compares CVD risk prediction tools in relation to HRV in HIV-infected.…”

Section: Discussionmentioning

confidence: 99%

Heart Rate Variability, HIV and the Risk of Cardiovascular Diseases in Rural South Africa

Godijk

Vos

Jongen

et al. 2020

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Background: Antiretroviral therapy (ART) transformed human immunodeficiency virus (HIV) infection into a chronic disease. Possible HIV-associated complications have emerged including cardiovascular diseases (CVD). Objectives: This study aims to determine the heart rate variability (HRV) distribution and association between HRV and HIV treated with ART in a rural African population. Methods: This cross-sectional study included 325 participants of the Ndlovu Cohort Study, South Africa. HRV was measured using a standardized five-minute resting ECG and assessed by the standard deviation of normal RR intervals (SDNN), root of mean squares of successive RR differences (RMSSD), percentage of RR intervals greater than 50 milliseconds different from its predecessor (pNN50), total-, low-and high-frequency power. CVD risk factors were assessed using measurements (blood pressure, anthropometry, cholesterol) and questionnaires (e.g. socio-demographics, alcohol, smoking, physical activity, age, diabetes). We used a Wilcoxon rank test to assess differences in medians between HIV-infected and HIV-uninfected participants and multivariable linear regression to investigate associations between HRV and HIV treated with ART. Conclusions: Of the participants, 196 (61.4%) were HIV-infected treated with ART and 123 (38.6%) were HIV-uninfected. HIV-infected consumed less alcohol, 52% versus 35%, smoked less, were less physically active, more often attained lower education, 26% versus 14%, and had lower systolic blood pressure, 134 mmHg versus 140 mmHg, compared to HIV-uninfected. Medians of all HRV parameters were lower for HIV-infected participants. The model fully adjusted for CVD risk factors showed a significant inverse association between HIV treated with ART and log RMSSD (-0.16) and log pnn50 (-0.61). Although HIV-infected participants treated with ART presented with less CVD risk factors they had a lower HRV indicating an increased risk of CVD. Highlights-African HIV-infected participants on ART had less conventional CVD risk factors than HIV-uninfected. -However, HIV-infected participants had lower HRV than HIV-uninfected participants.-Lower HRV of the HIV-infected participants indicates that they are at a higher risk for CVD.

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“…The trend of rising CVD mortality in HIV-infected individuals is growing in importance (14). In 2010, 19% of HIV-infected individuals had at least one CVD [15,16].…”

Section: Discussionmentioning

confidence: 99%

Prediction of cardiovascular risk among male patients infected with human immunodeficiency virus in Vojvodina, Serbia: A single centre study

et al. 2019

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Introduction. Human immunodeficiency virus infection is a disease of the modern era and it is estimated that there are more than 30 million infected individuals worldwide. Although the major cause is still unclear, patients infected with human immunodeficiency virus are at higher risk of ardiovascular diseases by 61% compared to general population. Material and Methods. This study included 111 male patients infected with human immunodeficiency virus treated at the Clinic of Infectious Diseases, Novi Sad, Serbia from January 2008 to December 2018. Five cardiovascular risk scores were used: Data Collection on Adverse Events of Antihuman immunodeficiency virus Drugs, Framingham 10-year Heart Score, Framingham 5-year Heart Score, prediction algorithm for cardiovascular disease and atherosclerotic cardiovascular disease risk estimator, at the beginning of the treatment, whereas cardiovascular events were recorded during the following 10 years. Results. Data Collection on Adverse Events of Anti-human immunodeficiency virus Drugs, Framingham 10-year Heart Score, Framingham 5-year Heart Score, and prediction algorithm for cardiovascular disease are tools that can identify individuals infected with human immunodeficiency virus at cardiovascular risk with statistical significance. The prediction algorithm for cardiovascular disease provides superior risk estimation compared to other scores. The atherosclerotic cardiovascular disease risk estimator did not show to be a marker of cardiovascular risk prediction among this population of patients. Conlusion. The above mentioned cardiovascular risk prediction algorithms, developed for general population, and Data Collection on Adverse Events of Anti-human immunodeficiency virus Drugs score, specific for population infected with human immunodeficiency virus, allow accurate cardiovascular risk estimation. Until the development of more specific algorithms, these scores are adequate tools for identification of patients at risk, providing prevention measures and treatment of cardiovascular disease.

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

Cited by 29 publications

References 40 publications

HIV infection and electrocardiogram abnormalities: baseline assessment from the CHART cohort

HIV infection and electrocardiogram abnormalities: baseline assessment from the CHART cohort

Heart Rate Variability, HIV and the Risk of Cardiovascular Diseases in Rural South Africa

Prediction of cardiovascular risk among male patients infected with human immunodeficiency virus in Vojvodina, Serbia: A single centre study

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