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It has been found that current cardiovascular risk models underestimate cardiovascular events in both women and men of African origin in high income countries (HICs), while overestimating cardiovascular events for all people with HIV (PWH) in low and middle-income countries (LMICs).
Cardiovascular diseases are the leading cause of death globally and risk estimation is an essential component of cardiovascular disease prevention among people with HIV.
Researchers from Massachusetts General Hospital conducted a study to characterise how well atherosclerotic cardiovascular disease (ASCVD) risk scores used in clinical guidelines perform among people with HIV globally.
The findings were published in Lancet HIV on January 17, 2025.
The study used data from Randomized Trial to Prevent Vascular Events in HIV (REPRIEVE) to analyse individuals with HIV who were from low, middle and high-income countries across several continents.
Three key findings emerged.
Firstly, calibration suggested overprediction of risk in low-income and middle-income countries and corresponding underprediction of risk in high-income countries.
Secondly, in analyses restricted to people with HIV in high-income countries, the study found "underprediction by the PCE risk score among women (2·39) and black or African American participants (1·64)".
Lastly, improved calibration of the PCE risk score among people with HIV in high-income countries was achieved by multiplying the original score by 2·8 in black or African American women, 2.6 in women who were not black or African American, and 1·25 in black or African American men.
The study recommended additional research to develop risk scores accurate in predicting ASCVD among people with HIV in low-income and middle-income countries. The researchers found that for those in REPRIEVE, current risk models underestimated cardiovascular events in both women and black men in HICs, while overestimating cardiovascular events for all PWH in LMICs.
The research included 3,893 participants aged 40–75 years, with low-to-moderate traditional cardiovascular risk, not taking statin therapy. The REPRIEVE participants were enrolled from sites in 12 countries across Global Burden of Disease Study (GBD) regions. Researchers assessed the performance of the pooled cohort equations (PCE) risk score for ASCVD and the data-collection on adverse effects of anti-HIV drugs (D:A:D) risk score.
The global REPRIEVE trial, with its diverse population, is the first large-scale study aimed at preventing HIV-related heart disease. Researchers in Massachusetts General Hospital's multidisciplinary Metabolism Unit were among the first to demonstrate excess coronary plaque in people with HIV.
A global clinical trial mainly funded by the National Institutes of Health and presented at the 2024 Conference on Retroviruses and Opportunistic Infections (CROI) in Denver revealed that the elevated cardiovascular disease risk among people with HIV is even greater than predicted by a standard risk calculator in several groups, including Black people and cisgender women.
Also, the risk of having a first major cardiovascular event was also higher than previously predicted for people from high-income regions and those whose HIV replication was not suppressed below detectable levels.