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Cardiovascular Risk Prediction Models in People Living with HIV in Colombia
Angel A García-Peña1, Esther De-Vries2, Jairo Aldana-Bitar3
1PhD Program in Clinical Epidemiology and Department of Clinical Epidemiology and Biostatistics, Faculty of Medicine, Pontificia Universidad Javeriana, Bogotá, Cardiology Division; Department of Internal Medicine; Hospital Universitario San Ignacio, Pontificia Universidad Javeriana, Bogotá, Colombia.
Insights
Cardiovascular risk scores showed acceptable performance in predicting major adverse cardiovascular events (MACE) for people living with HIV. These tools aid in managing cardiovascular risk in this population.
Area of Science:
- Cardiology
- Infectious Diseases
- Public Health
Background:
- Individuals with HIV face elevated cardiovascular disease (CVD) risk.
- Cardiovascular risk (CVR) prediction scores are vital for personalized patient management.
- These scores guide decisions on follow-up, lipid-lowering therapy, and antiretroviral treatment.
Purpose of the Study:
- To assess the predictive accuracy of various CVR scores for major adverse cardiovascular events (MACE) over 5 and 10 years in an HIV-infected cohort.
- To compare the performance of Framingham, SCORE, PROCAM, ASCVD, and D:A:D scores.
Main Methods:
- Data from a Colombian HIV registry were analyzed.
- 808 adult patients with complete data for CVR score calculation and MACE determination were included.
- Receiver operating characteristic (ROC) curves were used to evaluate score performance.
Main Results:
- The study included 808 patients (mean age 35, 12% female).
- Most patients presented with low to very low CVR.
- All evaluated scores demonstrated acceptable performance, with no statistically significant differences in their predictive accuracy (Area Under ROC curves ranging from 0.89 to 0.92).
Conclusions:
- The assessed cardiovascular risk scores performed acceptably in HIV-infected individuals.
- These scores are particularly useful for identifying patients in low and very low cardiovascular risk categories.
Background:
People living with HIV are at increased risk of cardiovascular disease. Cardiovascular risk (CVR) prediction scores are powerful tools for individualized assessment that inform decision-making about follow-up frequency, hypolipemiant treatment intensification, and choice antiretroviral therapy.
Objectives:
The objectives of the study were to evaluate the performance of multiple cardiovascular assessment scores in predicting major adverse cardiovascular events (MACE) at 5 and 10 years. Framingham (2004, 2008, and Colombia-adjusted), SCORE, PROCAM, ASCVD, and D:A:D scores were included in the analysis.
Methods:
Data were obtained from a medical registry of adults living with HIV attended by a teaching hospital in Colombia. All patients with complete information necessary for risk score calculations and determination of MACE at 5 and 10 years were included in the study. Receiver operating characteristic curves (ROC) were generated using calculations with all the aforementioned models for every individual. Differences between curves were compared with De- Long's test.
Results:
A total of 808 patients were included in the analysis. Mean age was 35 years, and 12% were female. The majority of subjects had low and very low CVR. Eight MACE occurred during follow-up. Area under ROC curves were: Framingham (0.90), Framingham ATP3 (0.92), Framingham calibrated for Colombia (0.90), SCORE (0.92), PROCAM (0.92), ASCVD (0.89), and D:A:D (0.92), with no statistically significant differences.
Conclusions:
The evaluated scores had an acceptable performance for HIV-infected patients in the studied cohort, especially for those in low and very low risk categories.
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