Cardiovascular risk in HIV-infected individuals: A comparison of three risk prediction algorithms

Introduction: Cardiovascular (CV) risk is known to be increased in HIV-infected individuals. Our aim was to assess CV risk in HIV-infected adults. Methods: CV risk was estimated for each patient using three different risk algorithms: SCORE, the Framingham risk score (FRS), and DAD. Patients were cla...

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Bibliographic Details
Main Authors: Sara Policarpo, Teresa Rodrigues, Ana Catarina Moreira, Emília Valadas
Format: Article
Language:English
Published: Elsevier 2019-07-01
Series:Revista Portuguesa de Cardiologia (English Edition)
Online Access:http://www.sciencedirect.com/science/article/pii/S2174204919302053
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Summary:Introduction: Cardiovascular (CV) risk is known to be increased in HIV-infected individuals. Our aim was to assess CV risk in HIV-infected adults. Methods: CV risk was estimated for each patient using three different risk algorithms: SCORE, the Framingham risk score (FRS), and DAD. Patients were classified as at low, moderate or high CV risk. Clinical and anthropometric data were collected. Results: We included 571 HIV-infected individuals, mostly male (67.1%; n=383). Patients were divided into two groups according to antiretroviral therapy (ART): naïve (7.5%; n=43) or under ART (92.5%; n=528). The mean time since HIV diagnosis was 6.7±6.5 years in the naive group and 13.3±6.1 years in the ART group. Metabolic syndrome (MS) was identified in 33.9% (n=179) and 16.3% (n=7) of participants in the ART and naïve groups, respectively. MS was associated with ART (OR=2.7; p=0.018). Triglycerides ≥150 mg/dl (OR=13.643, p<0.001) was one of the major factors contributing to MS. Overall, high CV risk was found in 4.4% (n=23) of patients when the SCORE tool was used, in 20.5% (n=117) using the FRS, and in 10.3% (n=59) using the DAD score. The observed agreement between the FRS and SCORE was 55.4% (k=0.183, p<0.001), between the FRS and DAD 70.5% (k=0.465, p<0.001), and between SCORE and DAD 72.3% (k=0.347, p<0.001). Conclusion: On the basis of the three algorithms, we detected a high rate of high CV risk, particularly in patients under ART. The FRS was the algorithm that classified most patients in the high CV risk category (20.5%). In addition, a high prevalence of MS was identified in this patient group. Resumo: Introdução: O risco cardiovascular (RCV) pode estar aumentado em indivíduos com infeção por Vírus Imunodeficiência Humana (VIH). O objetivo deste trabalho foi avaliar o RCV em adultos infetados por VIH. Métodos: O RCV foi estimado utilizando três algoritmos diferentes, Score, Framingham Risk Score (FRSs-CVD) e DAD; os participantes foram classificados apresentando RCV baixo, moderado ou elevado. Recolheram-se dados clínicos e antropométricos. Resultados: Incluíram-se 571 indivíduos, maioritariamente do género masculino (67,1%; n=383). Dividiram-se os participantes em dois grupos, com e sem terapêutica antirretroviral (cTAR): naïve (7,5%; n=43) versus cTAR (92,5%; n=528). O tempo médio desde o diagnóstico da infeção por VIH foi 6,7±6,5 anos no grupo naïve e 13,3±6,1 anos no grupo cART. A síndrome metabólica (SM) foi identificada em 33,9% (n=179) e em 16,3% (n=7) dos participantes, respetivamente no grupo cART e no grupo naïve. Verificou-se um RCV elevado em 4,4% (n=23) dos participantes, com recurso à ferramenta Score, em 20,5% (n=117) utilizando a FRSs e em 10,3% dos participantes (n=59) utilizando a ferramenta DAD. A concordância observada entre FRSs e Score foi 55,4% (k=0,183; p<0,001), entre FRSs e DAD 70,5% (k=0,465; p<0,001) e entre Score e DAD 72,3% (k=0,347; p<0,001). Conclusão: Com recurso aos algoritmos utilizados, identificou-se uma presença significativa de elevado RCV, sendo a ferramenta FRSs-CVD a que classificou mais indivíduos na categoria de RCV elevado (20,5%), e simultaneamente verificou-se uma prevalência elevada de SM. Keywords: Cardiovascular risk, Metabolic syndrome, HIV/Acquired immunodeficiency syndrome, Portugal, Palavras-chave: Risco de doença cardiovascular, Síndrome metabólica, VIH/SIDA, Portugal
ISSN:2174-2049