Prediction of future cardiovascular events by Framingham, SCORE and asCVD risk scores is less accurate in HIV-positive individuals from the HIV-HEART Study compared with the general population

Adjustment of the Framingham index by abdominal aortic calcification scores enables a more accurate prediction of long-term cardiac events in general population aged 40 years and above: evidence from NHANES 2013-2014

BACKGROUND

Abdominal aortic calcification (AAC) is considered as a strong predictor of cardiovascular disease (CVD) events. Our study aimed to investigate whether the predicted risk for cardiac death with the Framingham risk score (FRS) could be further improved with the addition of AAC score in general population aged ≥ 40 years.

METHODS

A total of 2971 participants aged ≥ 40 years in the National Health and Nutrition Examination Surveys (NHANES) 2013-2014 were followed up. The Spearman's rank correlation was performed to explore the correlation between the AAC score and FRS. the Kaplan-Meier method was used to make cumulative cardiac death curve. Predictors of cardiac death was identified by multivariate Cox regression. Additionally, the predictive value of FRS alone and combined with AAC score was estimated by comparing the area under the receiver-operating characteristic (ROC) curve (AUC) and calculating Integrated Discrimination Improvement (IDI).

RESULTS

During a median of 70.50 months (interquartile range 58.43-82.57 months), 49 (1.649%) experienced cardiac death in the follow-up. The FRS was positively associated with AAC score. Both FRS and AAC score were independent predictors of cardiac death (hazard ratio 1.216; 95%CI 1.135 to 1.302; p < 0.00001; 1.159; 95%CI 1.109 to 1.211; p < 0.00001; respectively). Furthermore, Kaplan-Meier analysis demonstrated increased risk of cardiac death with increasing AAC score (log-rank 54.548, p<0.0001). The predictive value of FRS significantly was improved by adding with AAC score [increase in AUC from 0.734 to 0.780, p < 0.0001; IDI = 0.007, p = 0.013 ].

CONCLUSIONS

AAC score is positively related with Framingham index, and FBS adjusted by AAC score further improved the prediction risk for cardiac death in general population aged ≥ 40 years.

Incidence and risk factors regarding atherosclerotic cardiovascular disease in middle-aged and elderly people with HIV treated in Chongqing, China

BACKGROUND

Atherosclerotic cardiovascular disease (ASCVD) has become an increasingly common cause of death among people living with HIV (PLHIV) receiving successful antiretroviral therapy (ART). In Chongqing, approximately half of the PLHIV were middle-aged or elderly, and their diets were mainly high in salt, spices and oil; however, there is still a lack of relevant research on the risk factors and whether the disease burden of ASCVD is greater in these areas. This study was to investigate the risk of ASCVD in middle-aged and elderly PLHIV receiving ART and analyze the factors influencing high risk.

METHODS

A cross-sectional study was conducted at Chongqing Public Health Medical Center. Questionnaire surveys, physical examinations and laboratory examinations were used to collect information from PLHIV aged ≥ 45 years. Pooled cohort equations (PCEs) were used to calculate the 10-year ASCVD risk and analyze the influencing factors. The 10-year ASCVD risk score was used to define patients in the low-risk subgroup (< 7.5%) and high-risk subgroup (≥ 7.5%), and the risk factors were compared between the two groups.

RESULTS

In total, 463 PLHIV (median age 55.0 years, male 68.5%) were included, and the median duration of ART was 45.0 (15.0, 70.3) months. Of the 463 PLHIV, 13 (2.8%) had a known history of ASCVD. In the present study, 153 PLHIV (33.0%) were classified into the high-risk group, and 310 PLHIV (67.0%) were classified into the low-risk group. Compared with the low-risk group, the high-risk group was more likely to be female, older age, live in urban areas, be unemployed, have poor sleep quality, have higher low-density lipoprotein cholesterol (LDL-c), have higher total cholesterol (TC), and have diabetes and hypertension; however, coffee consumption was associated with a low risk of ASCVD. In addition, there were no differences in HIV viral load, CD4 + T-cell count, or duration on ART, or ART regimes between the two groups. According to multiple logistic regression, older age [odds ratio (OR) = 62.469, 95% CI 27.456, 142.134], female sex [OR = 9.635, 95% CI 4.384, 21.179], higher LDL-c levels [OR = 1.018, 95% CI 1.000, 1.036], accompanied hypertension [OR = 8.642, 95% CI 3.373, 22.143] and diabetes [OR = 10.806, 95% CI 3.787, 30.834] were found to be independent risk factors for the 10-year risk of ASCVD.

CONCLUSIONS

The overall 10-year ASCVD risk is great for middle-aged and elderly PLHIV in Chongqing, China. The risk factors for the 10-year risk of ASCVD were older age, female sex, elevated LDL-c level, and coexisting hypertension and diabetes.

Endothelial Glycocalyx Integrity in Treatment-Naïve People Living with HIV before and One Year after Antiretroviral Treatment Initiation

Endothelial glycocalyx (EG) derangement has been associated with cardiovascular disease (CVD). Studies on EG integrity among people living with HIV (PLWH), are lacking. We conducted a prospective cohort study among treatment-naïve PLWH who received emtricitabine/tenofovir alafenamide, combined with either an integrase strand transfer inhibitor (INSTI, dolutegravir, raltegravir or elvitegravir/cobicistat), or a protease inhibitor (PI, darunavir/cobicistat). We assessed EG at baseline, 24 (±4) and 48 (±4) weeks, by measuring the perfused boundary region (PBR, inversely proportional to EG thickness), in sublingual microvessels. In total, 66 consecutive PLWH (60 (90.9%) males) with a median age (interquartile range, IQR) of 37 (12) years, were enrolled. In total, 40(60.6%) received INSTI-based regimens. The mean (standard deviation) PBR decreased significantly from 2.17 (0.29) μm at baseline to 2.04 (0.26) μm (p = 0.019), and then to 1.93 (0.3) μm (p < 0.0001) at 24 (±4) and 48 (±4) weeks, respectively. PBR did not differ among treatment groups. PLWH on INSTIs had a significant PBR reduction at 48 (±4) weeks. Smokers and PLWH with low levels of viremia experienced the greatest PBR reduction. This study is the first to report the benefit of antiretroviral treatment on EG improvement in treatment-naïve PLWH and depicts a potential bedside biomarker and therapeutic target for CVD in PLWH.

Development and validation of a risk score for predicting inconsistent condom use with women among men who have sex with men and women

BACKGROUND

Men who have sex with men and women (MSMW) are the most important bridge population for HIV transmission. Condom use plays an important role for HIV infection. However the predictors for condom ues with females are not well characterized.

METHODS

This was a cross-sectional study. Participants were enrolled by four community-based organizations (CBOs) by offline (bathrooms, bars), and online (gay applications, chat room) from April to December 2019. Electronic questionnare was fulfilled after a face-to-face training led by CBOs. We identified predictors of inconsistent condom use with females by creating a risk score based on regression coefficients. We externally validated this score via an independent cross-sectional survey conducted in Zhejiang Province in 2021. A total of 917, 615 MSMW were included in analysis in 2019 and 2021, seperately.

RESULTS

Among 917 MSMW, 73.2% reported heterosexual behavior in the prior 6 months and 38.3% reported inconsistent condom use with females (ICUF) over that time. Compared with heterosexual/unsure MSMW, bisexual MSMW reported more male and female sex partners, higher proportion of inconsistent condom use with males, less commercial sex with males (p < 0.05). Four risky predictors of ICUF were identified: Duration of local residence ≦6 months; more than one male partner in the prior 6 months; inconsistent condom use with males in the prior 6 months; and never heard post-exposure prophylaxis (PEP). The proportions of respondents indicating ICUF in the low- (0), medium- (2-4) and high-risk (6-20) groups (according to our risk scoring system) were 11.7% (14/120), 26.9% (96/357), and 78.1% (125/160), respectively (P_trend < 0.001). In the validation survey, the respective proportions of those reporting ICUF were 13.4% (15/112), 17.8% (24/185) and 87.3% (96/110) (P_trend < 0.001).

CONCLUSIONS

We developed and validated a predictive risk score for ICUF among MSMW; four factors were identified, of which inconsistent condom use with men was the most important. Risk reduction intervention programs should focus on MSM who report inconsistent condom use with males, never heard PEP, having multiple partners and living in local less than 6 months.

Cardiovascular disease and risk assessment in people living with HIV: Current practices and novel perspectives

Human immunodeficiency virus (HIV) infection represents a major cardiovascular risk factor, and the cumulative cardiovascular disease (CVD) burden among aging people living with HIV (PLWH) constitutes a leading cause of morbidity and mortality. To date, CVD risk assessment in PLWH remains challenging. Therefore, it is necessary to evaluate and stratify the cardiovascular risk in PLWH with appropriate screening and risk assessment tools and protocols to correctly identify which patients are at a higher risk for CVD and will benefit most from prevention measures and timely management. This review aims to accumulate the current evidence on the association between HIV infection and CVD, as well as the risk factors contributing to CVD in PLWH. Furthermore, considering the need for cardiovascular risk assessment in daily clinical practice, the purpose of this review is also to report the current practices and novel perspectives in cardiovascular risk assessment of PLWH and provide further insights into the development and implementation of appropriate CVD risk stratification and treatment strategies, particularly in countries with high HIV burden and limited resources.

Prediction models for cardiovascular disease risk among people living with HIV: A systematic review and meta-analysis

Background

HIV continues to be a major global health issue. The relative risk of cardiovascular disease (CVD) among people living with HIV (PLWH) was 2.16 compared to non-HIV-infections. The prediction of CVD is becoming an important issue in current HIV management. However, there is no consensus on optional CVD risk models for PLWH. Therefore, we aimed to systematically summarize and compare prediction models for CVD risk among PLWH.

Methods

Longitudinal studies that developed or validated prediction models for CVD risk among PLWH were systematically searched. Five databases were searched up to January 2022. The quality of the included articles was evaluated by using the Prediction model Risk Of Bias ASsessment Tool (PROBAST). We applied meta-analysis to pool the logit-transformed C-statistics for discrimination performance.

Results

Thirteen articles describing 17 models were included. All the included studies had a high risk of bias. In the meta-analysis, the pooled estimated C-statistic was 0.76 (95% CI: 0.72-0.81, I ² = 84.8%) for the Data collection on Adverse Effects of Anti-HIV Drugs Study risk equation (D:A:D) (2010), 0.75 (95% CI: 0.70-0.79, I ² = 82.4%) for the D:A:D (2010) 10-year risk version, 0.77 (95% CI: 0.74-0.80, I ² = 82.2%) for the full D:A:D (2016) model, 0.74 (95% CI: 0.68-0.79, I ² = 86.2%) for the reduced D:A:D (2016) model, 0.71 (95% CI: 0.61-0.79, I ² = 87.9%) for the Framingham Risk Score (FRS) for coronary heart disease (CHD) (1998), 0.74 (95% CI: 0.70-0.78, I ² = 87.8%) for the FRS CVD model (2008), 0.72 (95% CI: 0.67-0.76, I ² = 75.0%) for the pooled cohort equations of the American Heart Society/ American score (PCE), and 0.67 (95% CI: 0.56-0.77, I ² = 51.3%) for the Systematic COronary Risk Evaluation (SCORE). In the subgroup analysis, the discrimination of PCE was significantly better in the group aged ≤40 years than in the group aged 40-45 years (P = 0.024) and the group aged ≥45 years (P = 0.010). No models were developed or validated in Sub-Saharan Africa and the Asia region.

Conclusions

The full D:A:D (2016) model performed the best in terms of discrimination, followed by the D:A:D (2010) and PCE. However, there were no significant differences between any of the model pairings. Specific CVD risk models for older PLWH and for PLWH in Sub-Saharan Africa and the Asia region should be established.Systematic Review Registration: PROSPERO CRD42022322024.

Profile of cardiovascular disease risk in type 2 diabetes mellitus patients receiving statin therapy: A cross-sectional study

Background

Cardiovascular disease is still the number 1 cause of death globally. Meanwhile, type 2 diabetes mellitus (T2DM) is a risk factor for atherosclerosis vascular disease (ASCVD), so an assessment using Framingham Risk Score (FRS) is needed to predict the risk of ASCVD in the future.

Objective

Analyzing the risk factor of ASCVD using the Framingham Risk Score (FRS) in T2DM patients.

Methods

This study was conducted from July 2020 to July 2021, which the participants were measured for FRS including age, gender, current smoking, diabetes, blood pressure (systolic), high-density lipoprotein (HDL) cholesterol, total cholesterol (TC), and ASCVD risk score. The analysis employed multiple linear tests and ANOVA tests with p < 0.05.

Results

Several ASCVD risk factors in T2DM patients were found, including gender (t = 6.015; p < 0.001), age (t = 6.901; p < 0.001), HDL level (t = 2.287; p = 0.024), CT level (t = 5.273; p < 0.001), blood pressure (t = 5.850; p < 0.001), and current smoking (t = 2.638; p = 0.009). The results of analysis between ASCVD risk factor and level of ASCVD risk obtained a significant association (F = 36,642; p < 0.001).

Conclusion

Risk factors of ASCVD in T2DM patients such as gender, age, HDL level, CT level, blood pressure, and current smoking.

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Risk factors of ASCVD include gender, age, HDL level, CT level, blood pressure, and current smoking in T2DM patients.

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Significant ASCVD risk factors are age, gender, TC level, and blood pressure.

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The Framingham Risk Score is used to predict ASCVD in T2DM patients in the next 10 years.