Use of Coronary Artery Calcium Scoring to Improve Cardiovascular Risk Stratification and Guide Decisions to Start Statin Therapy in People Living With HIV

Abstract

Background: Cardiovascular disease (CVD) risk assessment remains a critical step in guiding decisions to initiate primary prevention interventions in people living with HIV (PLWH). Setting: We investigated whether coronary artery calcium (CAC) scoring allowed a more accurate selection of patients who may benefit from statin therapy, compared with current risk assessment tools alone. Methods: Cross-sectional analysis of PLWH over 50 years old who underwent CAC scoring between 2009 and 2019. Framingham Risk score (FRS), QRISK2 and D:A:D scores were calculated for each participant at the time of CAC scoring and statin eligibility determined based on current European guidelines on the prevention of CVD in PLWH. Results: A total of 739 patients were included (mean age 56 ± 5, 92.8% male, 84% white). Among 417 (56.4%) candidates for statin therapy based on FRS ≥10%, 174 (23.5%) had no detectable calcification (CAC = 0). Conversely, 145 (19.6%) patients with detectable calcification (CAC > 0) were identified as low-risk (FRS < 10%). When compared with FRS, CAC scoring reclassified CVD risk in 43.1% of patients, 145 (19.6%) to a higher risk group that could benefit from statin therapy and 174 (23.5%) statin candidates to a lower risk group. QRISK2 and D:A:D scores performed similarly to FRS, underestimating the presence of significant coronary calcification in 21.1% and 24.9% respectively and overestimating risk in 16.9% and 18.8% patients with CAC = 0. Conclusions: Establishing a decision-model based on the combination of conventional risk tools and CAC scoring improves risk assessment and the selection of PLWH who would benefit from statin therapy.

Coronary Artery Calcification and Plaque Characteristics in People Living With HIV: A Systematic Review and Meta‐Analysis

“…We identified 119 articles for full review on literature search, of which 43 articles were retained. 4 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 Of the retained articles, 22 represented multiple publications from 6 different studies, * yielding 27 unique studies included in the meta‐analyses ( Table ). The aforementioned 22 articles were retained because they provided complementary data to the information reported in the leading articles.…”

The association of epicardial adipose tissue volume and density with coronary calcium in HIV-positive and HIV-negative patients

“…Raggi et al has demonstrated that calcium scores >100 is an independent risk factor for cardiac events in HIV-positive patients (8). In addition, Paerira et al have demonstrated the utility of calcium scores to reclassify individual risk in HIV-positive populations (20).…”

Comparing Coronary Artery Calcium Scoring With Cardiac Risk Scores for Predicting Cardiovascular Events in Primary Care Patients in Saudi Arabia

“…Several studies have evaluated each score individually or in combination with other risk estimators. Pereira et al demonstrated that when the CAC score was combined with other scores, such as QRISK2 and FRS, they improved the risk assessment in HIV patients [27]. Likewise, others have demonstrated that using the ASCVD score can improve CAC prediction and thus enhance the type of treatment provided to CAC patients [28].…”