by Carolyn Chu, MD, MSc, AAHIVS, AAHIVM Chief Medical Officer

January 3, 2023

Featured Literature:
Soares C, Kwok M, Boucher, K, et al.  Performance of cardiovascular risk prediction models among people living with HIV: a systematic review and meta-analysis.  JAMA Cardiol.  2022 Dec 28.  doi:10.1001/jamacardio.2022.4873.  PMID 36576812.  

This meta-analysis compared comprehensive data from studies of various cardiovascular disease risk scores to assess how well they perform in PWH, to help inform optimal preventive care for PWH. Retrospective or prospective cohort studies with cardiovascular outcomes (MI, CVD, coronary artery disease) were included if they involved adult PWH and had available data on at least 1 cardiac risk score. 11 publications representing data from 9 epidemiological studies (published 2016-2019) of 75,304 PWH were included: participants were (values given as weighted averages) 42 years of age, 79% male, 59% White, 86% receiving ART, 50% current smokers, 5% had comorbid diabetes, and 25% had comorbid hypertension. Together, studies assessed 6 general population CVD risk prediction models (including the Framingham Risk Score and ACC/AHA Pooled Cohort Equation) and 4 HIV-specific models (including two D:A:D models, the HIVMI score, and VACS Index). Overall, studies were assessed to be at low risk for bias, and models performed moderately in differentiating people at higher versus lower risk of future CVD events. The D:A:D 2016 model, Framingham Risk Score (FRS), and Pooled Cohort Equation (PCE) 10-year risk models appeared to have the highest performance. Models tended to underpredict CVD risk by 20-50%, except for the FRS and PCE 10-year scores, and limited data suggest model predictive capability may vary by sex and race.

Author’s Commentary:

Cardiovascular disease remains highly prevalent among PWH, and CVD development may further increase as PWH age and develop associated comorbidities such as hypertension, hyperlipidemia, and diabetes (some of which may be attributable to contemporary ARV use).  Findings from this meta-analysis affirm that most non-HIV-specific risk scores significantly underpredict CVD risk among PWH (up to 50%) and also help identify which models may be most informative for use in clinical practice when reviewing CVD risk with patients.  Authors note study findings also help confirm that HIV infection should be considered a CVD risk-enhancing factor – as is currently recommended by many professional society guidelines.  

The author has no conflicts of interest to disclose.

View archived Clinical Research Update entries here.