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Coronary artery plaque progression and cardiovascular risk scores in men with and without HIV-infection
Kashif Shaikh1,2, Fiona Bhondoekhan3, Sabina Haberlen3
1Lundquist Institute of Biomedical Research at Harbor-UCLA Medical Center, Torrance, California.
Insights
Cardiovascular disease risk scores like PCE and FRS better predict coronary artery plaque progression in HIV-uninfected men than in those with HIV. New risk scores are needed for effective cardiovascular disease prevention in HIV-infected individuals.
Area of Science:
- Cardiology
- Infectious Diseases
- Public Health
Background:
- Cardiovascular disease (CVD) is a significant concern for individuals with HIV.
- Traditional CVD risk scores may not accurately assess risk in this population.
- Coronary artery plaque (CAP) progression is a key indicator of CVD development.
Purpose of the Study:
- To evaluate the association between established CVD risk scores and CAP progression.
- To compare the predictive performance of these scores in HIV-infected versus HIV-uninfected men.
- To identify the need for improved risk assessment tools in HIV-infected individuals.
Main Methods:
- Study included 495 men from the Multicenter AIDS Cohort Study (MACS) CVD study (211 HIV-uninfected, 284 HIV-infected).
- Coronary artery plaque (CAP) was assessed using cardiac computed tomography angiography (CCTA) at baseline and follow-up.
- Associations between baseline risk scores (Pooled Cohort Equation - PCE, Framingham Risk Score - FRS, D:A:D score) and CAP progression (total and noncalcified plaque volume) were examined.
Main Results:
- PCE and FRS risk categories showed stronger associations with CAP progression in HIV-uninfected men compared to HIV-infected men.
- For HIV-uninfected men in the high-risk PCE category, plaque progression was significantly higher (aOR 9.4 for TPV, 7.7 for NCPV).
- For HIV-infected men, the D:A:D score identified a greater percentage of men with plaque progression, though with lower specificity than PCE and FRS.
Conclusions:
- Established CVD risk scores (PCE, FRS) are less effective in predicting CAP progression in HIV-infected individuals.
- The D:A:D score shows potential but requires further validation for plaque progression prediction in HIV.
- Development of novel or improved CVD risk scores is crucial for targeted prevention strategies in the HIV-infected population.
Objective:
The aim of this study was to assess the association of cardiovascular disease (CVD) risk scores and coronary artery plaque (CAP) progression in HIV-infected participants.
Methods:
We studied men with and without HIV-infection enrolled in the Multicenter AIDS Cohort Study (MACS) CVD study. CAP at baseline and follow-up was assessed with cardiac computed tomography angiography (CCTA). We examined the association between baseline risk scores including pooled cohort equation (PCE), Framingham risk score (FRS), and Data collect of Adverse effects of anti-HIV drugs equation (D:A:D) and CAP progression.
Results:
We studied 495 men (211 HIV-uninfected, 284 HIV-infected). The adjusted odds ratio (aOR) of total plaque volume (TPV) and noncalcified plaque volume (NCPV) progression in the highest relative to lowest tertile was 9.4 [95% confidence interval (95% CI) 2.4-12.1, P < 0.001)] and 7.7 (95% CI 3.1-19.1, P < 0.001) times greater, respectively, among HIV-uninfected men in the PCE atherosclerotic cardiovascular disease (ASCVD) high vs. low-risk category. Among HIV-infected men, the association for TPV and NCPV progression for the same PCE risk categories, odds ratio (OR) 2.8 (95% CI 1.4-5.8, P < 0.01) and OR 2.4 (95% CI 1.2-4.8, P < 0.05), respectively (P values for interaction by HIV = 0.02 and 0.08, respectively). Similar results were seen for the FRS risk scores. Among HIV-uninfected men, PCE high risk category identified the highest proportion of men with plaque progression in the highest tertile, although in HIV-infected men, high-risk category by D:A:D identified the greatest percentage of men with plaque progression albeit with lower specificity than FRS and PCE.
Conclusion:
PCE and FRS categories predict CAP progression better in HIV-uninfected than in HIV-infected men. Improved CVD risk scores are needed to identify high-risk HIV-infected men for more aggressive CVD risk prevention strategies.
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