Level of agreement between frequently used cardiovascular risk calculators in people living with HIV
S Dhillon, C A Sabin, J Alagaratnam, E Bagkeris, F A Post, M Boffito, J Anderson, J Vera, I Williams, M Johnson, M Sachikonye, D Babalis, P W Mallon, A Winston, Pharmacokinetic and Clinical Observations in People over Fifty (POPPY) study, Amalia Ndoutoumou, David Asboe, Lucy Garvey, Anton Pozniak, Amanda Clarke, Andrew Bexley, Celia Richardson, Sarah Kirk, Rebecca Gleig, Margherita Bracchi, Nicole Pagani, Maddalena Cerrone, Daniel Bradshaw, Francesca Ferretti, Chris Higgs, Elisha Seah, Stephen Fletcher, Michelle Anthonipillai, Ashley Moyes, Katie Deats, Irtiza Syed, Clive Matthews, Peter Fernando, Chido Chiwome, Shane Hardwick, Sifiso Mguni, Rebecca Clark, Rhiannon Nevin-Dolan, Sambasivarao Pelluri, Lucy Campbell, Selin Yurdakul, Sara Okumu, Louise Pollard, Beatriz Santana-Suarez, Alan Macken, Bijan Ghavani-Kia, Joanne Maher, Maria Byrne, Ailbhe Flaherty, Sumesh Babu, Damilola Otiko, Laura Phillips, Rosanna Laverick, Michelle Beynon, Anna-Lena Salz, Abigail Severn, Jonathan Underwood, Lavender Tembo, Matthew Stott, Linda McDonald, Felix Dransfield, Andrew Whitehouse, Laura Burgess, Nnenna Ngwu, Nargis Hemat, Martin Jones, Anne Carroll, Sabine Kinloch, Mike Youle, Sara Madge, S Dhillon, C A Sabin, J Alagaratnam, E Bagkeris, F A Post, M Boffito, J Anderson, J Vera, I Williams, M Johnson, M Sachikonye, D Babalis, P W Mallon, A Winston, Pharmacokinetic and Clinical Observations in People over Fifty (POPPY) study, Amalia Ndoutoumou, David Asboe, Lucy Garvey, Anton Pozniak, Amanda Clarke, Andrew Bexley, Celia Richardson, Sarah Kirk, Rebecca Gleig, Margherita Bracchi, Nicole Pagani, Maddalena Cerrone, Daniel Bradshaw, Francesca Ferretti, Chris Higgs, Elisha Seah, Stephen Fletcher, Michelle Anthonipillai, Ashley Moyes, Katie Deats, Irtiza Syed, Clive Matthews, Peter Fernando, Chido Chiwome, Shane Hardwick, Sifiso Mguni, Rebecca Clark, Rhiannon Nevin-Dolan, Sambasivarao Pelluri, Lucy Campbell, Selin Yurdakul, Sara Okumu, Louise Pollard, Beatriz Santana-Suarez, Alan Macken, Bijan Ghavani-Kia, Joanne Maher, Maria Byrne, Ailbhe Flaherty, Sumesh Babu, Damilola Otiko, Laura Phillips, Rosanna Laverick, Michelle Beynon, Anna-Lena Salz, Abigail Severn, Jonathan Underwood, Lavender Tembo, Matthew Stott, Linda McDonald, Felix Dransfield, Andrew Whitehouse, Laura Burgess, Nnenna Ngwu, Nargis Hemat, Martin Jones, Anne Carroll, Sabine Kinloch, Mike Youle, Sara Madge
Abstract
Objectives: The aim of the study was to describe agreement between the QRISK2, Framingham and Data Collection on Adverse Events of Anti-HIV Drugs (D:A:D) cardiovascular disease (CVD) risk calculators in a large UK study of people living with HIV (PLWH).
Methods: PLWH enrolled in the Pharmacokinetic and Clinical Observations in People over Fifty (POPPY) study without a prior CVD event were included in this study. QRISK2, Framingham CVD and the full and reduced D:A:D CVD scores were calculated; participants were stratified into 'low' (< 10%), 'intermediate' (10-20%) and 'high' (> 20%) categories for each. Agreement between scores was assessed using weighted kappas and Bland-Altman plots.
Results: The 730 included participants were predominantly male (636; 87.1%) and of white ethnicity (645; 88.5%), with a median age of 53 [interquartile range (IQR) 49-59] years. The median calculated 10-year CVD risk was 11.9% (IQR 6.8-18.4%), 8.9% (IQR 4.6-15.0%), 8.5% (IQR 4.8-14.6%) and 6.9% (IQR 4.1-11.1%) when using the Framingham, QRISK2, and full and reduced D:A:D scores, respectively. Agreement between the different scores was generally moderate, with the highest level of agreement being between the Framingham and QRISK2 scores (weighted kappa = 0.65) but with most other kappa coefficients in the 0.50-0.60 range.
Conclusions: Estimates of predicted 10-year CVD risk obtained with commonly used CVD risk prediction tools demonstrate, in general, only moderate agreement among PLWH in the UK. While further validation with clinical endpoints is required, our findings suggest that care should be taken when interpreting any score alone.
Keywords: HIV; Data Collection on Adverse Events of Anti-HIV Drugs (D:A:D) risk score; Framingham; QRISK2; agreement; cardiovascular risk prediction.
© 2019 The Authors. HIV Medicine published by John Wiley & Sons Ltd on behalf of British HIV Association.
Source: PubMed