Comparison of the ACC/AHA and Framingham algorithms to assess cardiovascular risk in HIV-infected patients

Area of Science:

• Cardiology
• Infectious Diseases
• Public Health

Background:

• Cardiovascular disease (CVD) is a significant concern in individuals with HIV.
• Accurate cardiovascular risk assessment is crucial for timely intervention in HIV patients.
• Existing risk scores may not adequately predict CVD events in this population.

Purpose of the Study:

• To compare the predictive performance of the Framingham cardiovascular risk score (FRS) and the American College of Cardiology/American Heart Association (ACC/AHA) risk score.
• To evaluate the agreement between FRS and ACC/AHA scores in an HIV outpatient clinic.
• To identify potential underestimation of high-risk patients by these scores in an HIV-infected population.

Main Methods:

• A cross-sectional study involving 341 HIV-infected patients over 40 years old.
• Data collection through interviews.
• Statistical analysis using Cohen's kappa coefficient and Spearman correlation to assess agreement between risk scores.

Main Results:

• Framingham risk score classified 61.3% as low risk versus 54% by ACC/AHA score (Spearman correlation 0.845; p<0.000).
• Only 26.1% were high risk by Framingham compared to 46% by ACC/AHA (Kappa=0.745; p<0.039).
• Framingham score significantly underestimated high-risk patients, with only one patient identified as high risk prior to a myocardial infarction event.

Conclusions:

• Both cardiovascular risk scores, particularly Framingham, tend to underestimate high-risk patients within this HIV-infected cohort.
• The findings suggest that current risk prediction models may require recalibration or modification for HIV-positive individuals.
• Improved cardiovascular risk stratification tools are needed for effective management of CVD in the HIV population.