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Comparative Study
. 2013 Dec 10;81(24):2094-102.
doi: 10.1212/01.wnl.0000437296.97946.73. Epub 2013 Nov 8.

Long-term predictive value of the Framingham Risk Score for Stroke in HIV-positive vs HIV-negative men

Farrah J Mateen  1 , Wendy S Post, Ned Sacktor, Alison G Abraham, James T Becker, Bryan R Smith, Roger Detels, Eileen Martin, John P Phair, Russell T Shinohara; Multicenter AIDS Cohort Study (MACS) Investigators
Affiliations
Comparative Study

Long-term predictive value of the Framingham Risk Score for Stroke in HIV-positive vs HIV-negative men

Farrah J Mateen et al. Neurology. .

Abstract

Objective: To test the predictive accuracy of the Framingham Risk Score for Stroke (FRS-S) in HIV-infected (HIV+) vs HIV-uninfected (HIV-) men.

Methods: The Multicenter AIDS Cohort Study (MACS) is an ongoing prospective study of HIV+ and HIV- men who have sex with men (MSM) enrolled in 4 US cities. We ascertained all reported stroke events during a recent 15-year timeframe (July 1, 1996 to June 30, 2011) among 3,945 participants (1,776 HIV+ and 2,169 HIV-). For those with strokes, FRS-S were calculated 10 years before the stroke event and assessed according to HIV status.

Results: A total of 114 stroke events occurred, including 57 HIV+ and 37 HIV- participants with first-ever strokes and 19 fatal strokes. The incidence of first-ever stroke was 1.7/1,000 person-years among HIV- and 3.3/1,000 person-years among HIV+ participants. Among those with strokes, HIV+ participants were younger than HIV- participants (median age 51.3 vs 61.8 years, p < 0.0001). For these men with stroke, the average 10-year risk of stroke was higher for HIV- MSM (6.6% [range 3%-26%] vs 4.9% for HIV+ MSM [range 0%-15%], p < 0.04). Traditional risk factors for stroke were similar among the Framingham cohort and the MACS HIV+ and HIV- participants.

Conclusions: FRS-S prediction was systematically different in HIV+ vs HIV- men with stroke events. The FRS-S underestimates the long-term risk of stroke in HIV+ men.

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Figures

Figure 1
Figure 1. Histograms of FRS-S point composition of the entire MACS cohort at the beginning of the HAART era
FRS-S points for all MACS participants by HIV serostatus. FRS-S = Framingham Risk Score for Stroke; HAART = highly active antiretroviral therapy; MACS = Multicenter AIDS Cohort Study.
Figure 2
Figure 2. Histograms of FRS-S point composition of the MACS participants who experienced a stroke during the study timeframe
FRS-S points for MACS participants with stroke by HIV serostatus. FRS-S = Framingham Risk Score for Stroke; MACS = Multicenter AIDS Cohort Study.
See this image and copyright information in PMC

References

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