Prediction of Cardiovascular Risk Among People with HIV Using the PREVENT Equations Compared to the Pooled Cohort...

Area of Science:

• Cardiology
• Public Health
• Infectious Diseases

Background:

• People with HIV (PWH) face higher atherosclerotic cardiovascular disease (ASCVD) risks.
• Existing risk calculators often underestimate ASCVD risk in PWH.
• The American Heart Association's PREVENT equations have not been evaluated in PWH.

Purpose of the Study:

• Compare 10-year ASCVD risk predictions between PREVENT and Pooled Cohort Equations (PCE) in PWH.
• Assess the impact of PREVENT on statin therapy recommendations for PWH.
• Identify potential disparities in ASCVD risk assessment among PWH.

Main Methods:

• Cross-sectional observational study utilizing real-world electronic health records.
• Included PWH aged 40-75 without pre-existing cardiovascular disease.
• Compared ASCVD risk predicted by PREVENT and PCE, and analyzed statin eligibility based on current guidelines.

Main Results:

• PREVENT predicted significantly lower 10-year ASCVD risk (median 3.3%) compared to PCE (median 7.7%) in PWH.
• 97% of individuals had lower predicted risk with PREVENT.
• Statin recommendations decreased from 67.3% with PCE to 28.6% with PREVENT using a 5% ASCVD risk threshold.

Conclusions:

• The PREVENT equations underestimate ASCVD risk in PWH compared to PCE.
• This underestimation could lead to 58% fewer PWH being recommended for statins, potentially increasing cardiovascular disease events.
• Lowered risk prediction may exacerbate healthcare disparities among PWH.