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Measuring Frailty in HIV-infected Individuals. Identification of Frail Patients is the First Step to Amelioration and Reversal of Frailty
Published on: July 24, 2013
Identifying HIV patients with an unfavorable cardiovascular risk profile in the clinical practice: results from the
Giuseppe Vittorio L De Socio1, Giustino Parruti, Tiziana Quirino
1Department of Infectious Diseases, Santa Maria Hospital, Perugia, Italy. giuseppedesocio@yahoo.it
Insights
This study identified 36% of HIV patients as high cardiovascular risk using Framingham Risk Score and Metabolic Syndrome criteria. Smoking was the main predictor, with lipodystrophy and CD4 counts linked to worse cardiovascular risk profiles.
Area of Science:
- Cardiology
- Infectious Diseases
- Public Health
Background:
- Cardiovascular disease (CVD) is a significant concern in HIV-infected patients.
- Accurate risk assessment is crucial for managing CVD in this population.
- Existing risk algorithms may need validation in HIV cohorts.
Purpose of the Study:
- To identify and characterize HIV-infected patients at higher cardiovascular risk in clinical settings.
- To compare the performance of different cardiovascular risk algorithms.
- To identify clinical factors associated with increased cardiovascular risk in HIV patients.
Main Methods:
- A multicenter, nationwide cross-sectional study of 1230 HIV-infected patients.
- Cardiovascular risk was assessed using Framingham Risk Score (FRS), PROCAM, PROGETTO CUORE, and SCORE algorithms.
- Metabolic Syndrome (MS) was diagnosed using National Cholesterol Education Program definitions.
Main Results:
- The Framingham Risk Score (FRS) provided the highest estimate of cardiovascular risk.
- 36% of patients were classified as high risk (FRS ≥10% and/or MS).
- Smoking was the primary predictor of increased cardiovascular risk; lipodystrophy and higher CD4 T-cell counts were associated with worse risk profiles.
Conclusions:
- The FRS algorithm appears most effective for estimating cardiovascular risk in HIV patients.
- Clinical indicators like lipodystrophy and CD4 T-cell counts are valuable markers for heightened cardiovascular risk.
- These findings support enhanced cardiovascular risk stratification and management strategies for HIV-infected individuals.
Objective:
To identify and characterize HIV-infected patients at higher cardiovascular risk in ordinary clinical settings.
Design:
Multicenter, nationwide cross-sectional study.
Methods:
Consecutive HIV-patients, attending scheduled visits at facilities involved in the Italian coordination group for the study of allergies and HIV infection (CISAI), were included between February and April, 2005. Their 10-year probability of acute coronary events was calculated using the Framingham Risk Score (FRS) as well as 3 other cardiovascular algorithms ("PROCAM", "PROGETTO CUORE", "SCORE"); Metabolic Syndrome (MS) was diagnosed according to the National Cholesterol Education Program definitions. An estimated 10-year CVD >or=10% and/or MS led to the diagnosis of high CV risk. We compared selected clinical features between high- and low-risk patients.
Results:
A total of 1230 HIV infected patients (72% males, mean age of 43+/-9 years), 185 of whom treatment-naive, were evaluated. FRS gave the highest estimate of CV risk. The mean 10-year risk for acute coronary events according to FRS was 7.4+/-7.0. MS was present in 22% of the observed patients. Accordingly, 443 patients (36%) were classified at high risk. Twelve percent of the patients (n=142) had both a FRS >or=10% and a diagnosis of MS. The main single predictor of increased cardiovascular risk was smoking (60% of whole sample). A higher prevalence of clinically evident lipodystrophy and a higher CD4 T-cell counts were found both in patients with higher FRS and in patients with high FRS and MS (both p<0.001).
Conclusions:
The worst estimation of CV risk was obtained with the FRS algorithm. Clinical evidence of lipodystrophy and higher CD4 T-cell counts were closely associated to a worse cardiovascular risk profile.
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