Abstract 19787: Cardiovascular Risk Assessment in the South Texas HIV+ Cohort: Is Risk Estimation or Risk Categorization More Appropriate for Patient Counseling?
Introduction: Existing cardiovascular disease (CVD) risk calculators underestimate the risk of CVD among people with human immunodeficiency virus (HIV+). This is the first study to compare CVD risk estimations and categories in an HIV+ cohort using AHA, Framingham (FRC), and D:A:D (Data collection on Adverse Effects of Anti-HIV Drugs Study) calculators.
Methods: Of patients seen in a public HIV clinic in South Texas ≥2 times in 2013, 668 HIV+ adults >40 years old without prevalent CVD had sufficient data for CVD risk calculations. Patients’ continuous 10 year CVD risks were estimated by three calculators and compared pairwisely using Wilcoxon signed-rank test. Patients were classified into risk categories per guidelines for each risk calculation, which differ: AHA: 10y risk<7.5% Low, ≥7.5% High; FRC: 10y risk <10% Low, 10-20% Moderate, >20% High; D:A:D: 5y risk <1% Low, 1-5% Moderate, ≥5% High. The proportion of patients at high risk was compared with McNemar’s test.
Results: Mean patient age was 49.8y (SD=6.2), 79.9% were men, 63.3% Hispanic, 19.6% white non-Hispanic, 14.7% African American, mean BMI was 27.9 kg/m2 (SD=5.6), 41.6% were treated for hypertension, and 17.2% had diabetes. HIV disease was relatively controlled, with 85.2% on antiretroviral therapy and 69% virologically suppressed. Median estimated 10y CVD risk was highest with FRC (all p<0.001, Table). The percentage of patients classified at high risk ranged from 20.4% to 44.2%, with D:A:D placing the highest proportion of patients into a high risk group (all p<0.001).
Conclusions: Risk calculators behaved differently based on whether continuous risk estimates or categorical risk classifications were used. Median 10-year risk was highest with FRC, yet D:A:D classified the highest proportion of patients at elevated risk. Since CVD risk calculators underestimate risk for HIV+ adults, clinicians may find the risk categorization with AHA or D:A:D calculators more appropriate for patient counseling.
- Cardiovascular Risk Calculator
- Framingham Risk Calculator
- ASCVD Risk Estimator
- D:A:D Risk Calculator
Author Disclosures: Y. Liang: None. N.S. Ketchum: None. B.J. Turner: None. J.M. Flores: None. D. Bullock: None. R. Villarreal: None. P.H. Noel: None. M.T. Yin: None. B.S. Taylor: Research Grant; Significant; AHA Mentored Clinical and Population Research Award.
- © 2015 by American Heart Association, Inc.