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Mind the gap: difference between Framingham heart age and real age increases with age in HIV-positive individuals-a
Teri-Louise Davies1, Mark Gompels, Sarah Johnston
1School of Social and Community Medicine, University of Bristol, Bristol, UK.
Insights
HIV-positive individuals have an increased cardiovascular disease (CVD) risk, with "heart age" exceeding real age, particularly influenced by smoking. This highlights the importance of smoking cessation for managing CVD in this population.
Area of Science:
- Cardiology
- Infectious Diseases
- Public Health
Background:
- HIV infection is associated with an increased risk of cardiovascular disease (CVD).
- Assessing CVD risk in HIV-positive individuals is crucial for preventative strategies.
- The concept of 'heart age' can be a tool to communicate risk effectively.
Purpose of the Study:
- To measure the excess CVD risk in HIV-positive individuals by comparing 'heart age' to chronological age.
- To identify patient characteristics associated with heart age deviation (heart age minus real age).
- To evaluate the utility of 'heart age' in communicating CVD risk and promoting smoking cessation.
Main Methods:
- A clinical cohort study was conducted with 749 HIV-positive adults.
- Framingham 10-year CVD risk was calculated to determine 'heart age'.
- Fractional polynomial regression analyzed the relationship between heart age deviation and real age, and patient characteristics.
Main Results:
- Heart age was significantly higher than real age, with smoking status being a major determinant (e.g., 45-year-old male smoker had a heart age of 60).
- Heart age deviation increased with chronological age and was influenced by sex, with differences observed at various ages.
- Higher CD4 counts were associated with increased heart age deviation compared to lower counts.
Conclusions:
- HIV-positive individuals exhibit an elevated heart age compared to their real age, influenced by age, CD4 count, and smoking.
- Heart age serves as a valuable tool for patient communication regarding CVD risk and the benefits of smoking cessation.
- Further research and clinical application of the 'heart age' concept are warranted in HIV management.
Objectives:
To measure the excess risk of cardiovascular disease (CVD) in HIV-positive individuals by comparing 'heart age' with real age and to estimate associations of patients' characteristics with heart age deviation (heart age-real age).
Design:
Clinical Cohort Study.
Setting:
Bristol HIV clinic, Brecon Unit at Southmead Hospital, Bristol, UK.
Participants:
749 HIV-positive adults who attended for care between 2008 and 2011. Median age was 42 years (IQR 35-49), 67% were male and 82% were treated with antiretroviral therapy.
Main Outcome Measures:
We calculated the Framingham 10-year risk of CVD and traced back to 'heart age', the age of an individual with the same score but ideal risk factor values. We estimated the relationship between heart age deviation and real age using fractional polynomial regression. We estimated crude and mutually adjusted associations of sex, age, CD4 count, viral load/treatment status and period of starting antiretroviral therapy with heart age deviation.
Results:
The average heart age for a male aged 45 years was 48 years for a non-smoker and 60 years for a smoker. Heart age deviation increased with real age and at younger ages was smaller for females than males, although this reversed after 48 years. Compared to patients with CD4 count <500 cells/mm(3), heart age deviation was 2.4 (95% CI 0.7 to 4.0) and 4.3 (2.3 to 6.3) years higher for those with CD4 500-749 cells/mm(3) and ≥750 cells/mm(3), respectively.
Conclusions:
In HIV-positive individuals, the difference between heart age and real age increased with age and CD4 count and was very dependent on smoking status. Heart age could be a useful tool to communicate CVD risk to patients and the benefits of stopping smoking.
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