Cardiovascular disease is the leading cause of morbidity and mortality globally, particularly threatening people with human immunodeficiency virus (HIV). To address this, risk prediction models, such as atherosclerotic cardiovascular disease risk assessment, are used to estimate the risk of heart disease.
However, previous studies have questioned the effectiveness of these models among people with HIV, especially in low- and middle-income countries.
Researchers from Massachusetts General Hospital, a founding member of the Mass General Brigham healthcare system, in collaboration with an international team of scientists, conducted a study to evaluate how well existing atherosclerotic cardiovascular disease risk estimates could predict cardiovascular outcomes in global populations with HIV. Their findings are published in Lancet HIV.
In their prospective cohort study, they used data from the Randomized Trial to Prevent Vascular Events in HIV to analyze individuals with HIV from low-, middle-, and high-income countries across several continents. They found that in women and black men from high-income countries, current risk models underestimated cardiovascular events, while for all people with HIV in low- and middle-income countries, the risk was overestimated.
“These findings allow researchers to refine cardiovascular disease prediction models for people living with HIV,” said Dr. Patrice Desvigne-Nickens from the National Heart, Lung, and Blood Institute. “Assessing the accuracy of these predictions in population subgroups was possible thanks to a carefully developed outreach program and a diverse study population.”
Dr. Steven Grinspoon, co-author of the study and chief of the Metabolism Unit at Massachusetts General Hospital, agrees. “This study highlights the need for detailed, region-specific, and population-specific cardiovascular disease prediction models that accurately reflect the cardiovascular risk for people with HIV, including those living in low- and middle-income countries,” he explains.
“Our team calculated correction factors for the underestimated risks, and future work is needed to validate these values in external cohort studies. We hope that experts from guideline committees will recognize our findings and may consider stronger treatment recommendations for women and black or African American men with HIV in high-income countries,” added Dr. Markella Zanni, head of Women’s Health Research in the Metabolism Unit at Massachusetts General Hospital.