Cardiovascular Disease Risk Prediction in the HIV Outpatient Study

Abstract

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 χ2 P 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.

Keywords: HIV; cardiovascular disease; risk prediction.

Conflict of interest statement

Potential conflicts of interest. K. A. L. has served on the advisory board for Gilead Sciences, has received research support from AbbVie and Gilead Sciences, and has given CME Lectures for Simply Speaking and Integrity. F. J. P. has served on the advisory board for Gilead Sciences and Janssen Pharmaceuticals; has served on speaker’s bureaus for Gilead Sciences, Janssen Pharmaceuticals, Merck, and Bristol-Myers Squibb; and has received grant funding support from Bristol-Myers Squibb. All other authors report no potential conflicts. All authors have submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Conflicts that the editors consider relevant to the content of the manuscript have been disclosed.

Published by Oxford University Press for the Infectious Diseases Society of America 2016. This work is written by (a) US Government employee(s) and is in the public domain in the US.

Figures

Figure 1

Flowchart of the included HIV Outpatient Study population. Abbreviations: CVD, cardiovascular disease; HDL, high-density lipoprotein; HIV, human immunodeficiency virus; HOPS, HIV Outpatient Study.