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Long-term predictive value of the Framingham Risk Score for Stroke in HIV-positive vs HIV-negative men

Farrah J Mateen1, Wendy S Post, Ned Sacktor

  • 1From the Department of Neurology (F.J.M.), Massachusetts General Hospital, Boston; Departments of International Health (F.J.M., N.S.), and Epidemiology (W.S.P., A.G.A.), Bloomberg School of Public Health, and Department of Medicine, Division of Cardiology (W.S.P.), the Johns Hopkins University, Baltimore; Department of Neurology (N.S., B.R.S.), the Johns Hopkins Hospital, Baltimore, MD; Departments of Neurology, Psychiatry, and Psychology (J.T.B.), University of Pittsburgh, PA; Department of Epidemiology, School of Public Health (R.D.), and Department of Medicine, School of Medicine (R.D.), University of California, Los Angeles; Department of Psychiatry (E.M.), Rush University Medical Center, Chicago; Feinberg School of Medicine (J.P.P.), Division of Infectious Diseases, Northwestern University, Chicago, IL; and Department of Biostatistics and Epidemiology (R.T.S.), Perelman School of Medicine, University of Pennsylvania, Philadelphia.

Neurology
|November 12, 2013
PubMed

Insights

The Framingham Risk Score for Stroke (FRS-S) underestimates stroke risk in HIV-infected men. This study highlights the need for improved stroke prediction models in this population.

Area of Science:

  • Cardiology
  • Infectious Diseases
  • Epidemiology

Background:

  • Cardiovascular disease is a leading cause of morbidity and mortality in people with HIV.
  • Accurate stroke risk prediction is crucial for effective primary prevention strategies.
  • The Framingham Risk Score for Stroke (FRS-S) is a widely used tool, but its performance in HIV-infected populations is not well-established.

Purpose of the Study:

  • To evaluate the predictive accuracy of the Framingham Risk Score for Stroke (FRS-S) in HIV-infected versus HIV-uninfected men.
  • To determine if FRS-S adequately captures stroke risk in the context of HIV infection.

Main Methods:

  • Prospective cohort study (Multicenter AIDS Cohort Study - MACS) of HIV-infected (HIV+) and HIV-uninfected (HIV-) men who have sex with men (MSM).
  • Ascertainment of stroke events over a 15-year period (1996-2011) among 3,945 participants.
  • Calculation of FRS-S 10 years prior to stroke events and assessment by HIV status.

Main Results:

  • Stroke incidence was higher in HIV+ participants (3.3/1,000 person-years) compared to HIV- participants (1.7/1,000 person-years).
  • HIV+ men experiencing stroke were significantly younger than HIV- men (median age 51.3 vs 61.8 years).
  • FRS-S indicated a higher average 10-year stroke risk in HIV- men (6.6%) than in HIV+ men (4.9%), despite higher incidence in the HIV+ group.

Conclusions:

  • The Framingham Risk Score for Stroke (FRS-S) demonstrates systematically different predictions between HIV-infected and HIV-uninfected men.
  • FRS-S underestimates the long-term risk of stroke in HIV-infected men.
  • Current stroke risk assessment tools may require modification for HIV-infected individuals.
Abstract

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