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Prevalence of Cardiovascular Disease and Comparison of Risk Category Predictions of Systemic Coronary Risk Evaluation
Elif Tükenmez Tigen1, Deniz Gökengin2, Hülya Özkan Özdemir3
1Department of Infectious Diseases and Clinical Microbiology, Marmara University Hospital, İstanbul, Türkiye.
Insights
Cardiovascular disease (CVD) is a significant concern for people living with HIV (PLWH). This study found high CVD risk in PLWH, with varying tool effectiveness and low lipid-lowering therapy use.
Area of Science:
- Cardiology
- Infectious Diseases
- Public Health
Background:
- Cardiovascular disease (CVD) is a leading cause of death in people living with HIV (PLWH).
- Assessing CVD prevalence and risk in PLWH is crucial for effective management.
Purpose of the Study:
- To evaluate the prevalence of diagnosed CVD in PLWH.
- To assess CVD risk using five different risk prediction tools.
- To compare the performance of various CVD risk assessment tools in PLWH.
Main Methods:
- Retrospective, cross-sectional study in 20 Turkish tertiary centers.
- 1425 PLWH aged 40-75 years included.
- Web-based tools used for calculating 10-year atherosclerotic CVD risk score (ASCVD), Framingham heart study risk score (FRS), modified FRS, data collection on adverse effects of anti-HIV drugs (DAD), and systemic coronary risk evaluation 2 (SCORE2).
Main Results:
- 10.8% of PLWH had diagnosed CVD.
- 42.8% had ASCVD risk >7.5%; 71.7% had high/very high risk per SCORE2.
- Significant variation in agreement between CVD risk tools was observed.
Conclusions:
- High CVD prevalence underscores the need for cardiovascular monitoring in PLWH.
- SCORE2 identified more high-risk individuals than other tools.
- Low uptake of lipid-lowering therapy indicates a gap in CVD prevention strategies.
Background:
Cardiovascular disease (CVD) is a major cause of mortality among people living with HIV (PLWH). We aimed to assess the prevalence of diagnosed CVD and the risk of CVD among PLWH using 5 different tools.
Methods:
This retrospective, cross-sectional study was conducted in 20 tertiary centers in Türkiye between October 2021 and March 2022, among 1425 PLWH aged 40-75 years. About 82.7% were male, with a median age of 51. Web-based tools for each score were used for CVD risk calculations.
Results:
Of 1425 PLWH enrolled, 10.8% had confirmed CVD, and 1132 had their risk scores evaluated. Of those participants, 42.8% had a higher risk of CVD (10-year risk of atherosclerotic CVD risk score (ASCVD) above 7.5%), and according to the European Society of Cardiology systemic coronary risk evaluation 2 (SCORE2), 71.7% had a high- to very high-risk rate. The agreement between various CVD risk tools varied, with Framingham heart study risk score (FRS), modified FRS, data collection on adverse effects of anti-HIV drugs (DAD), and SCORE2 for high-risk countries showing overall agreement rates of 82%, 94%, 91%, and 36%, respectively, compared to ASCVD. According to the 2021 European and 2019 American Cardiology guidelines, 75.3% and 47.1% of PLWH would be eligible for lipid-lowering agents, respectively.
Conclusion:
The diagnosed CVD prevalence highlighted the importance of monitoring cardiovascular health and comorbidities in this population. SCORE2 identified a greater number of individuals at high/very high risk compared to other prediction tools. The implementation of CVD prevention through lipid-lowering therapy was far from desired levels in our cohort.
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