Comparison between the Framingham and prospective cardiovascular of Münster scores for risk assessment of coronary heart disease in human immunodeficiency virus-positive patients in Pernambuco, Brazil.
BACKGROUND
The Framingham score is used in most studies on human immunodeficiency virus (HIV)-positive patients to estimate the risk for coronary heart disease; however, it may have some limitations for detecting risk among these individuals.


OBJECTIVE
The aim of this study was to evaluate the agreement between the Framingham and Prospective Cardiovascular of Münster (PROCAM) scores among HIV-positive individuals and to investigate the factors associated with disagreement between the two scores.


METHODS
A cross-sectional study was conducted in a population of HIV/acquired immunodeficiency syndrome (AIDS) patients attending the outpatient's clinics of two reference centers for HIV/AIDS in Pernambuco, Brazil. Agreement between the Framingham and PROCAM scores was evaluated using the kappa index. From this analysis, a variable called "disagreement between scores" was created, and univariate and multivariate analysis were performed to investigate the factors associated with this variable.


RESULTS
The prevalence of low, moderate, and high risk were, respectively, 78.7%, 13.5%, and 7.8% by Framingham score and 88.5%, 4.3%, and 7.2% by PROCAM (kappa = 0.64, P ≤ 0.0001). Agreement in the subgroup with metabolic syndrome by the International Diabetes Federation (IDF) (kappa = 0.51, P ≤ 0.0001) and the National Cholesterol Education Program (NCEP) (kappa = 0.59, P ≤ 0.0001) criteria was moderate. The Framingham score identified greater proportion of women with moderate risk. Factors independently associated with disagreement were: smoking, sex, age, low-density lipoprotein cholesterol, diastolic blood pressure, and metabolic syndrome.


CONCLUSIONS
There was a good agreement between the Framingham and PROCAM scores in HIV-positive patients, but a higher proportion of moderate-high risk was identified by the Framingham score. This disagreement should be evaluated in cohort studies to observe clinical outcomes over the course of time.
Barros
Zoraya Medeiros
ZM
Departamento de Medicina Clínica, Universidade de Pernambuco, Recife, Pernambuco, Brazil. zorayabarros@yahoo.com.br
de Alencar Ximenes
Ricardo Arraes
RA
Miranda-Filho
Demócrito Barros
DB
de Albuquerque
Maria de Fátima Pessoa Militão
Mde F
Melo
Heloísa Ramos Lacerda
HR
Carvalho
Erico Higino
EH
Gelenske
Thais
T
Diniz
George
G
Bandeira
Francisco
F
D000328:Adult; D000465:Algorithms; D001938:Brazil / Q000453:epidemiology; D002320:Cardiovascular Physiological Phenomena; D015331:Cohort Studies; D003327:Coronary Disease / Q000150:complications* / Q000175:diagnosis* / Q000453:epidemiology* / Q000503:physiopathology; D003430:Cross-Sectional Studies; D005260:Female; D006679:HIV Seropositivity / Q000150:complications* / Q000453:epidemiology* / Q000503:physiopathology; D015497:HIV-1 / Q000276:immunology; D006801:Humans; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D012107:Research Design; D018570:Risk Assessment / Q000379:methods