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. 2022 Nov 15;23(1):1395.
doi: 10.4102/sajhivmed.v23i1.1395. eCollection 2022.

Comparative performance of cardiovascular risk prediction models in people living with HIV

Irtiza S Tahir  1 , Alinda G Vos  1   2 , Johanna A A Damen  3 , Roos E Barth  4 , Hugo A Tempelman  5 , Diederick E Grobbee  1 , Karine Scheuermaier  1   6 , Willem D F Venter  2 , Kerstin Klipstein-Grobusch  1   7
Affiliations

Comparative performance of cardiovascular risk prediction models in people living with HIV

Irtiza S Tahir et al. South Afr J HIV Med. .

Abstract

Background: Current cardiovascular risk assessment in people living with HIV is based on general risk assessment tools; however, whether these tools can be applied in sub-Saharan African populations has been questioned.

Objectives: The study aimed to assess cardiovascular risk classification of common cardiovascular disease (CVD) risk prediction models compared to the Data Collection on Adverse Events of Anti-HIV Drugs (D:A:D) 2010 and 2016 models in people living with HIV.

Method: Cardiovascular disease risk was estimated by Framingham Cardiovascular and Heart Disease (FHS-CVD, FHS-CHD), Atherosclerotic Cardiovascular Disease (ASCVD) and D:A:D 2010 and 2016 risk prediction models for HIV-infected participants of the Ndlovu Cohort Study, Limpopo, rural South Africa. Participants were classified to be at low (< 10%), moderate (10% - 20%), or high-risk (> 20%) of CVD within 10 years for general CVD and five years for D:A:D models. Kappa statistics were used to determine agreement between CVD risk prediction models. Subgroup analysis was performed according to age.

Results: The analysis comprised 735 HIV-infected individuals, predominantly women (56.7%), average age 43.9 (8.8) years. The median predicted CVD risk for D:A:D 2010 and FHS-CVD was 4% and for ASCVD and FHS-CHD models, 3%. For the D:A:D 2016 risk prediction model, the figure was 5%. High 10-year CVD risk was predicted for 2.9%, 0.5%, 0.7%, 3.1% and 6.6% of the study participants by FHS-CVD, FHS-CHD, ASCVD, and D:A:D 2010 and 2016. Kappa statistics ranged from 0.34 for ASCVD to 0.60 for FHS-CVD as compared to the D:A:D 2010 risk prediction model.

Conclusion: Overall, predicted CVD risk is low in this population. Compared to D:A:D 2010, CVD risk estimated by the FHS-CVD model showed similar overall results for risk classification. With the exception of the D:A:D model, all other risk prediction models classified fewer people to be at high estimated CVD risk. Prospective studies are needed to develop and validate CVD risk algorithms in people living with HIV in sub-Saharan Africa.

Keywords: Atherosclerotic Cardiovascular Disease Risk Score; D:A:D risk score; Framingham risk score; cardiovascular disease risk; people living with HIV; sub-Saharan Africa.

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Conflict of interest statement

The authors declare that they have no financial or personal relationships that may have inappropriately influenced them in writing this article.

Figures

FIGURE 1
FIGURE 1
Flow chart of study.
FIGURE 2
FIGURE 2
Cumulative risk for all Ndlovu Cohort Study HIV-positive study participants for the cardiovascular disease risk prediction models.
FIGURE 3
FIGURE 3
Cardiovascular disease risk categories. The 10-year cardiovascular disease risk is depicted in three categories, low (< 10%), medium (10% – 20%), and high (> 20%).
FIGURE 1-A1
FIGURE 1-A1
Equations used to calculate individualised cardiovascular disease.
See this image and copyright information in PMC

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