Cardiovascular Disease Risk Prediction in the HIV Outpatient Study.
BACKGROUND
Cardiovascular disease (CVD) risk prediction tools are often applied to populations beyond those in which they were designed when validated tools for specific subpopulations are unavailable.


METHODS
Using data from 2283 human immunodeficiency virus (HIV)-infected adults aged ≥18 years, who were active in the HIV Outpatient Study (HOPS), we assessed performance of 3 commonly used CVD prediction models developed for general populations: Framingham general cardiovascular Risk Score (FRS), American College of Cardiology/American Heart Association Pooled Cohort equations (PCEs), and Systematic COronary Risk Evaluation (SCORE) high-risk equation, and 1 model developed in HIV-infected persons: the Data Collection on Adverse Effects of Anti-HIV Drugs (D:A:D) study equation. C-statistics assessed model discrimination and the ratio of expected to observed events (E/O) and Hosmer-Lemeshow χ2P value assessed calibration.


RESULTS
From January 2002 through September 2013, 195 (8.5%) HOPS participants experienced an incident CVD event in 15 056 person-years. The FRS demonstrated moderate discrimination and was well calibrated (C-statistic: 0.66, E/O: 1.01, P = .89). The PCE and D:A:D risk equations demonstrated good discrimination but were less well calibrated (C-statistics: 0.71 and 0.72 and E/O: 0.88 and 0.80, respectively; P < .001 for both), whereas SCORE performed poorly (C-statistic: 0.59, E/O: 1.72; P = .48).


CONCLUSIONS
Only the FRS accurately estimated risk of CVD events, while PCE and D:A:D underestimated risk. Although these models could potentially be used to rank US HIV-infected individuals at higher or lower risk for CVD, the models may fail to identify substantial numbers of HIV-infected persons with elevated CVD risk who could potentially benefit from additional medical treatment.
Division of HIV/AIDS Prevention.|Epidemic Intelligence Service.
Angela M
AM
Thompson-Paul
National Jewish Health, Denver, Colorado.
Kenneth A
KA
Lichtenstein
Cerner Corporation, Kansas City, Missouri.
Carl
C
Armon
Feinberg School of Medicine, Northwestern University, Chicago, Illinois.
Frank J
FJ
Palella
Division of HIV/AIDS Prevention.
Jacek
J
Skarbinski
Feinberg School of Medicine, Northwestern University, Chicago, Illinois.
Joan S
JS
Chmiel
Cerner Corporation, Kansas City, Missouri.
Rachel
R
Hart
Division of HIV/AIDS Prevention.
Stanley C
SC
Wei
Division of Heart Disease and Stroke Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia.
Fleetwood
F
Loustalot
Division of HIV/AIDS Prevention.
John T
JT
Brooks
Division of HIV/AIDS Prevention.
Kate
K
Buchacz
D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use; D002318:Cardiovascular Diseases / Q000453:epidemiology / Q000209:etiology* / Q000235:genetics; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000188:drug therapy / Q000821:virology; D006801:Humans; D008297:Male; D008499:Medical Records; D008875:Middle Aged; D010045:Outpatients; D018570:Risk Assessment; D012307:Risk Factors
D019380:Anti-HIV Agents
HIV; cardiovascular disease; risk prediction