Global assessment leaves more questions than answers.
A new comparison of cardiovascular risk calculators reminds us that no single tool is sufficient to help us decide when, and how, we pursue cardiovascular disease prevention interventions with our patients living with HIV. The study reveals that patient-by-patient results can often differ among some of our most popular prediction models, and that individual assessment and shared decision-making are still critical in determining clinical next steps.
Highlighted Study Population and Methods
The study investigators compared atherosclerotic cardiovascular (ASCVD) risk prediction in people with HIV using three contemporary equations and data from the REPRIEVE clinical trial. (REPREIVE was a global study of 7,757 people living with HIV who had no ASCVD and low-to-intermediate calculated risk; they were randomized to receive either pitavastatin or placebo for primary cardiovascular disease prevention.) The number of participants meeting statin eligibility thresholds per current HIV treatment guidelines was also assessed.
The three cardiovascular risk prediction models used were:
Pooled Cohort Equations (PCE), which is used in current U.S. guidelines and shown to underpredict ASCVD in people with HIV.
PREVENT, a newer U.S. model introduced by the American Heart Association.
SCORE2, a new model incorporated into current European AIDS Clinical Society guidelines.
Key Findings
Median 10-year predicted risk was highest with PCE (4.4%), followed by SCORE2 (3.3%), and then PREVENT (2.2%).
Compared to PCE, PREVENT reclassified 38% of participants from >5% to <5% risk; SCORE2 reclassified 27%.
Estimated incidence of major adverse cardiovascular events (MACE) was highest using PREVENT compared to PCE.
The five-year number needed to treat (NNT5) for the PREVENT lower risk group (2.5-5%) was similar to the PCE-defined > 5% risk group.
The authors conclude that the use of newer CVD risk models could result in reduced statin prescribing and increased MACE events over time.
Read an expert analysis from Benjamin Young, M.D., Ph.D. at TheBodypro.
Source : TheBodyPro
Related HIV and Co-Infections News
Get involved
Are you living with HIV/AIDS? Are you part of a community affected by HIV/AIDS and co-infections? Do you work or volunteer in the field? Are you motivated by our cause and interested to support our work?
Subscribe
Stay in the loop and get all the important EATG updates in your inbox with the EATG newsletter. The HIV & co-infections bulletin is your source of handpicked news from the field arriving regularly to your inbox.