Proportion of patients eligible for statin therapy substantially varies between different cardiovascular disease risk...

Area of Science:

• Cardiology
• Infectious Diseases
• Public Health

Background:

• People living with HIV (PLWH) have a higher risk of cardiovascular disease (CVD).
• Integrating CVD prevention into routine HIV care is crucial.
• Current risk assessment tools may not adequately capture CVD risk in PLWH.

Purpose of the Study:

• To compare the agreement between three CVD risk scores in PLWH.
• To evaluate the indication for statin therapy based on different guidelines.
• To assess the potential underestimation of CVD risk by physicians.

Main Methods:

• Cross-sectional, single-center study of 488 PLWH aged 30+ without prior CVD or statin use.
• Agreement between D:A:D-R, SCORE, and FRS risk scores was assessed using Cohen's kappa coefficient.
• Statin therapy indication was determined using American Heart Association and European AIDS Clinical Society guidelines.

Main Results:

• The D:A:D-R score identified the highest proportion of patients at high/very high CVD risk (17.8%).
• Agreement between risk scores was poor (D:A:D-R vs. SCORE: κ=0.11; D:A:D-R vs. FRS: κ=0.33).
• Indication for statin therapy varied widely (34.8% to 92.0%) based on the risk equation and guidelines used.

Conclusions:

• A significant proportion of PLWH face high CVD risk, potentially underestimated in clinical practice.
• Inconsistent CVD risk assessment and prophylaxis strategies require attention.
• An interdisciplinary approach is needed to optimize CVD risk management in PLWH.