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
Abstract
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. METHOD: 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. CONCLUSION: 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.
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HIV-specific indices such as the DAD CV index may be more accurate than the Framingham index in HIV-infected populations.
“While it predicts cardiovascular events, the thresholds may vary from HIV-uninfected populations and may under-estimate risk and HIV-specific indices (e.g., DAD CV index) that may be more accurate (62–64)”
From HIV and Aging: State of Knowledge and Areas of Critical Need for Research. A Report to the NIH Office of AIDS Research by the HIV and Aging Working Group (2012) · cites this paper as [63]
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- Authors
- Barros, Z. M., de Alencar Ximenes, R. A., Miranda-Filho, D. B., de Albuquerque, M. D. F. P. M., Melo, H. R. L., Carvalho, É. H., Gelenske, T., Diniz, G., & Bandeira, F.
- Affiliations
- Departamento de Medicina Clínica, Universidade de Pernambuco, Recife, Pernambuco, Brazil.
- Universidade de Pernambuco (BR)
- Departamento de Medicina Tropical, Universidade Federal de Pernambuco, Recife, Pernambuco, Brazil.
- Serviço de Endocrinologia, Instituto de Medicina Interna Prof. Fernando Figueira, Recife, Pernambuco, Brazil.
- Instituto Aggeu Magalhães (BR)
- Venue
- Metabolic Syndrome and Related Disorders
- Publisher
- SAGE Publications
- Published
- 2010-12
- Volume
- 8
- Issue
- 6
- Pages
- 489-497
- ISSN
- 1540-4196 (ISSN-L)
- 1557-8518
- OpenAlex
- W1972524622
- Cited by
- 16
- References
- 43
- Citations by year
- 2023: 1 · 2021: 1 · 2020: 1 · 2019: 3 · 2015: 1 · 2014: 1 · 2013: 4 · 2012: 3
- FWCI
- 2.44
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Metabolic Syndrome and Related Disorders (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Emergency Medicine › HIV-related health complications and treatments
- Health Sciences › Medicine › Surgery › Lipoproteins and Cardiovascular Health
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Health Promotion and Cardiovascular Prevention
- Keywords
- Framingham risk score, PROCAM risk score, coronary heart disease risk, people living with HIV, AIDS, cardiovascular risk assessment, metabolic syndrome, smoking, LDL cholesterol, diastolic blood pressure, sex differences in risk
- MeSH terms
- Adult, Algorithms, Brazil, Cardiovascular Physiological Phenomena, Coronary Disease, Cross-Sectional Studies, Female, HIV Seropositivity, Humans, Male, Middle Aged, Research Design, Cohort Studies, HIV-1, Prevalence, Risk Assessment
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