title: Cardiovascular disease risk prediction by the American College of Cardiology (ACC)/American Heart Association (AHA) Atherosclerotic Cardiovascular Disease (ASCVD) risk score among HIV-infected patients in sub-Saharan Africa.
abstract: OBJECTIVE
  HIV-infected patients are at increased risk for cardiovascular disease (CVD). However, general population CVD risk prediction equations that identify HIV-infected patients at elevated risk have not been widely assessed in sub-Saharan African (SSA).
  
  
  METHODS
  HIV-infected adults from 30-50 years of age with documented viral suppression were enrolled into a cross-sectional study in Gaborone, Botswana. Participants were screened for CVD risk factors. Bilateral carotid intima-media thickness (cIMT) was measured and 10-year predicted risk of cardiovascular disease was calculated using the Pooled Cohorts Equation for atherosclerotic CVD (ASCVD) and the 2008 Framingham Risk Score (FRS) (National Cholesterol Education Program III-NCEP III). ASCVD ≥7.5%, FRS ≥10%, and cIMT≥75th percentile were considered elevated risk for CVD. Agreement in classification of participants as high-risk for CVD by cIMT and FRS or ASCVD risk score was assessed using McNemar`s Test. The optimal cIMT cut off-point that matched ASCVD predicted risk of ≥7.5% was assessed using Youden's J index.
  
  
  RESULTS
  Among 208 HIV-infected patients (female: 55%, mean age 38 years), 78 (38%) met criteria for ASCVD calculation versus 130 (62%) who did not meet the criteria. ASCVD classified more participants as having elevated CVD risk than FRS (14.1% versus 2.6%, McNemar's exact test p = 0.01), while also classifying similar proportion of participants as having elevated CVD like cIMT (14.1% versus 19.2%, McNemar's exact test p = 0.34). Youden's J calculated the optimal cut point at the 81st percentile for cIMT to correspond to an ASCVD score ≥7.5% (sensitivity = 72.7% and specificity = 88.1% with area under the curve for the receiver operating characteristic [AUC] of 0.82, 95% Mann-Whitney CI: 0.66-0.99).
  
  
  CONCLUSIONS
  While the ASCVD risk score classified more patients at elevated CVD risk than FRS, ASCVD score classified similar proportion of patients as high risk when compared with established subclinical atherosclerosis. However, potential CVD risk category misclassification by established equations such as ASCVD may still exist among HIV-infected patients; hence there is still a need for development of a CVD risk prediction equation tailored to HIV-infected patients in SSA.
authors.affiliation: Department of Medicine, Faculty of Medicine, University of Botswana, Gaborone, Botswana.
authors.forename: Mosepele
authors.identifier: http://orcid.org/0000-0002-6051-0999
authors.initials: M
authors.lastname: Mosepele
authors.affiliation: The Heart Center, Division of Cardiology, Massachusetts General Hospital & Harvard Medical School, Boston, Massachusetts, United States of America.
authors.forename: Linda C
authors.initials: LC
authors.lastname: Hemphill
authors.affiliation: Department of Medicine, Faculty of Medicine, University of Botswana, Gaborone, Botswana.
authors.forename: Tommy
authors.initials: T
authors.lastname: Palai
authors.affiliation: Botswana-Harvard AIDS Institute Partnership, Gaborone, Botswana.
authors.forename: Isaac
authors.initials: I
authors.lastname: Nkele
authors.affiliation: Bennett Statistical Consulting Inc, Ballston Lake, New York, United States of America.
authors.forename: Kara
authors.initials: K
authors.lastname: Bennett
authors.affiliation: Botswana-Harvard AIDS Institute Partnership, Gaborone, Botswana.|Division of Infectious Diseases, Brigham & Women`s Hospital, Boston, Massachusetts, United States of America.|Department of Immunology & Infectious Diseases, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, United States of America.
authors.forename: Shahin
authors.initials: S
authors.lastname: Lockman
authors.affiliation: Division of General Internal Medicine & Division of Infectious Diseases, Massachusetts General Hospital & Harvard Medical School, Boston, Massachusetts, United States of America.
authors.forename: Virginia A
authors.initials: VA
authors.lastname: Triant
mesh_terms: D000328:Adult; D017954:Africa South of the Sahara / Q000453:epidemiology; D000572:American Heart Association; D050197:Atherosclerosis / Q000453:epidemiology* / Q000821:virology; D003430:Cross-Sectional Studies; D015658:HIV Infections / Q000150:complications / Q000453:epidemiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D018570:Risk Assessment; D014481:United States