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Level of agreement between frequently used cardiovascular risk calculators in people living with HIV
S Dhillon1, C A Sabin2, J Alagaratnam1
1Section of Retrovirology, Department of Medicine, St Mary's Hospital Campus, Imperial College London, London, UK.
Insights
Cardiovascular disease (CVD) risk calculators show moderate agreement in people living with HIV (PLWH). Healthcare providers should use caution when interpreting individual CVD risk scores alone for PLWH.
Area of Science:
- Cardiology
- Infectious Diseases
- Public Health
Background:
- Cardiovascular disease (CVD) is a significant concern for people living with HIV (PLWH).
- Accurate CVD risk assessment is crucial for effective prevention strategies in PLWH.
- Existing CVD risk calculators may perform differently in the PLWH population.
Purpose of the Study:
- To evaluate the agreement between QRISK2, Framingham, and Data Collection on Adverse Events of Anti-HIV Drugs (D:A:D) CVD risk calculators.
- To assess the performance of these tools in a large UK cohort of PLWH.
Main Methods:
- Utilized data from the Pharmacokinetic and Clinical Observations in People over Fifty (POPPY) study.
- Calculated 10-year CVD risk using QRISK2, Framingham, and D:A:D scores for 730 PLWH without prior CVD events.
- Assessed agreement using weighted kappas and Bland-Altman plots, stratifying participants into low, intermediate, and high-risk categories.
Main Results:
- Median 10-year CVD risk estimates varied across calculators, ranging from 6.9% (reduced D:A:D) to 11.9% (Framingham).
- Moderate agreement was observed between the calculators, with the highest agreement between Framingham and QRISK2 (weighted kappa = 0.65).
- Most other kappa coefficients fell within the 0.50–0.60 range, indicating generally moderate concordance.
Conclusions:
- Commonly used CVD risk prediction tools demonstrate only moderate agreement among PLWH in the UK.
- Further validation with clinical endpoints is necessary to confirm these findings.
- Clinical interpretation of any single CVD risk score in PLWH requires careful consideration due to observed variability.
Objectives:
The aim of the study was to describe agreement between the QRISK2, Framingham and Data Collection on Adverse Events of Anti-HIV Drugs (D:A:D) cardiovascular disease (CVD) risk calculators in a large UK study of people living with HIV (PLWH).
Methods:
PLWH enrolled in the Pharmacokinetic and Clinical Observations in People over Fifty (POPPY) study without a prior CVD event were included in this study. QRISK2, Framingham CVD and the full and reduced D:A:D CVD scores were calculated; participants were stratified into 'low' (< 10%), 'intermediate' (10-20%) and 'high' (> 20%) categories for each. Agreement between scores was assessed using weighted kappas and Bland-Altman plots.
Results:
The 730 included participants were predominantly male (636; 87.1%) and of white ethnicity (645; 88.5%), with a median age of 53 [interquartile range (IQR) 49-59] years. The median calculated 10-year CVD risk was 11.9% (IQR 6.8-18.4%), 8.9% (IQR 4.6-15.0%), 8.5% (IQR 4.8-14.6%) and 6.9% (IQR 4.1-11.1%) when using the Framingham, QRISK2, and full and reduced D:A:D scores, respectively. Agreement between the different scores was generally moderate, with the highest level of agreement being between the Framingham and QRISK2 scores (weighted kappa = 0.65) but with most other kappa coefficients in the 0.50-0.60 range.
Conclusions:
Estimates of predicted 10-year CVD risk obtained with commonly used CVD risk prediction tools demonstrate, in general, only moderate agreement among PLWH in the UK. While further validation with clinical endpoints is required, our findings suggest that care should be taken when interpreting any score alone.
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