Cardiovascular risk assessment in persons with HIV infection in the developing world: comparing three risk equations in a cohort of HIV-infected Thais: Cardiovascular risk in HIV-infected Thais
Abstract
OBJECTIVE: There is growing concern regarding cardiovascular disease in HIV-infected individuals in developing countries such as Thailand. We evaluated the 10-year risk of coronary heart disease (CHD) in a Thai HIV-infected cohort using three cardiovascular risk equations, and assessed the level of agreement among their predictions. METHODS: We carried out a cross-sectional analysis of data on 785 Thai subjects followed prospectively in the HIV Netherlands Australia Thailand Collaboration (HIV-NAT) cohort study from 1996 to 2009. Cardiovascular risk factor history, along with relevant laboratory and clinical data, was collected at follow-up clinic visits. Ten-year risks of CHD were calculated using the Framingham, Ramathibodi-Electricity Generating Authority of Thailand (Rama-EGAT) and Data Collection on Adverse Effects of Anti-HIV Drugs (D:A:D) risk equations. RESULTS: The mean age of the patients was 41.0 years; 55% of the subjects were male. The mean duration of antiretroviral therapy was 7.7 years. The prevalence of cardiovascular risk factors was low, with the most common risk factor being low high-density lipoprotein (HDL) (36.3%). The prevalence of high cardiovascular risk scores (defined as 10-year risk of CHD≥10%) was also low: 9.9, 2.1 and 0.8%, by the Framingham, Rama-EGAT and D:A:D scoring systems, respectively. Only eight subjects (1.0%) had a history of CHD. Bland-Altman plots showed that the Framingham equation predicted a higher risk of CVD compared with the Rama-EGAT and D:A:D equations, which agreed relatively well. CONCLUSION: The predicted cardiovascular risk in this HIV-infected Thai cohort was relatively low. The agreement among the Rama-EGAT and D:A:D risk scores suggests that both equations may be appropriate estimators of cardiovascular risk in this population.
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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 [62]
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- Authors
- Edwards-Jackson, N., Kerr, S., Tieu, H., Ananworanich, J., Hammer, S., Ruxrungtham, K., Phanuphak, P., Avihingsanon, A., & for the HIV-NAT 006 Study Team
- Affiliations
- Columbia University (US)
- New York Blood Center (US)
- Chulalongkorn University (TH)
- Corresponding author
- Avihingsanon, A
- Venue
- HIV Medicine
- Publisher
- Wiley
- Published
- 2011-03-06
- Volume
- 12
- Issue
- 8
- Pages
- 510-515
- ISSN
- 1464-2662 (ISSN-L)
- OpenAlex
- W1562761056
- Cited by
- 53
- References
- 14
- Citations by year
- 2024: 3 · 2023: 4 · 2022: 2 · 2021: 3 · 2020: 3 · 2019: 3 · 2018: 3 · 2017: 6 · 2016: 8 · 2015: 5 · 2014: 4 · 2013: 3 · 2012: 3
- FWCI
- 4.42
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- HIV Medicine (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Electricity Generating Authority of Thailand
- National Institute on Drug Abuse (R03DA026038)
- Topics
- Health Sciences › Medicine › Emergency Medicine › HIV-related health complications and treatments
- Health Sciences › Medicine › Surgery › Lipoproteins and Cardiovascular Health
- Health Sciences › Medicine › Infectious Diseases › HIV/AIDS Research and Interventions
- Keywords
- cardiovascular risk assessment, HIV infection, coronary artery disease, 10-year risk prediction, Framingham risk equation, cardiovascular risk factors, low HDL cholesterol, antiretroviral therapy, Thailand
- MeSH terms
- Adult, Australia, Cardiovascular Diseases, Coronary Artery Disease, Cross-Sectional Studies, Female, Humans, Male, Middle Aged, Netherlands, Thailand, Cohort Studies, HIV Infections, Risk Assessment, Antiretroviral Therapy, Highly Active
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