Global HIV Study Finds that Cardiovascular Risk Models Underestimate for Key Populations

Cardiovascular disease (CVD) is the leading cause of morbidity and mortality globally, posing a particularly significant threat to people with HIV (PWH). To address this, CVD prevention plans rely on prediction models like atherosclerotic cardiovascular disease (ASCVD) risk scores to estimate the risk of heart disease.

However, previous studies have called into question whether these commonly used prediction models perform well among people with HIV, and there remains a gap in understanding of what these scores mean for PWH in low- and middle-income countries (LMICs).

Researchers from Massachusetts General Hospital, a founding member of the Mass General Brigham healthcare system, in collaboration with an international team of investigators, conducted a study to evaluate how well existing ASCVD risk estimates could be used to predict cardiovascular outcomes in global populations with HIV. Their findings are published in Lancet HIV.

Their prospective cohort study used data from Randomized Trial to Prevent Vascular Events in HIV (REPRIEVE) to analyze individuals with HIV who were from low-, middle-, and high-income countries across several continents. The researchers found that for those in REPRIEVE, current risk models underestimated cardiovascular events in both women and black men in high income countries (HICs), while overestimating cardiovascular events for all PWH in LMICs.

“These findings allow researchers to fine-tune cardiovascular disease prediction models for people living with HIV,” said Patrice Desvigne-Nickens, MD, a medical officer within the National Heart, Lung, and Blood Institute (NHLBI). “Assessing the accuracy of these predictions in subgroups of the population is possible because of carefully developed outreach and enrolling a diverse study population – representing all people at risk.”

Steven Grinspoon, MD, a co-lead study author and chief of the Massachusetts General Hospital Metabolism Unit in the Endocrinology Division of the Department of Medicine, agrees. “This study underscores the need for nuanced, region-specific and population-specific CVD prediction models that accurately reflect cardiovascular risk for PWH, including those living in LMICs,” he explained.

“Our team calculated correction factors for the underestimates, with future work needed to validate these values in an external cohort. We anticipate that experts on guideline committees will recognize our findings and may consider stronger treatment recommendations for women and black or African American men living with HIV in HICs,” said co-lead author Markella Zanni, MD, director of Women's Health Research in the Metabolism Unit at Massachusetts General Hospital.

 

Authorship: In addition to Grinspoon and Zanni, Mass General Brigham authors include Virginia A. Triant. Marissa R. Diggs Sarah M. Chu, Kathleen V. Fitch, and Michael T. Lu.

Disclosures: Grinspoon reports grant support through his institution from NIH, Kowa Pharmaceuticals America, Inc., Gilead Sciences, Inc., and ViiV Healthcare for the conduct of the study; personal fees from Theratechnologies and ViiV; and service on the Scientific Advisory Board of Marathon Asset Management, all outside the submitted work. Zanni reports grant support through her institution from NIH/NIAID and Gilead Sciences, Inc., relevant to the conduct of the study, as well as grants from NIH/NIAID and NIH/NHLBI; support for attending CROI and International Workshop for HIV and Women from conference organizing committee when abstract reviewer and/or speaker; and participation in DSMB for NIH funded studies, outside the submitted work. Additional author disclosures can be found in the paper.

Funding: The National Institutes of Health supported the study and had a role in study design. Kowa Pharmaceuticals America, Gilead Sciences, and ViiV Healthcare provided financial support for the study but did not have a role in study design, collection, analysis, or interpretation of data, writing of the manuscript, or the decision to publish. This study is supported through NIH grants U01HL123336 and 1UG3HL164285, to the Clinical Coordinating Center, and U01HL123339 and 1U24HL164284, to the Data Coordinating Center. The NIAID supported this study through grants UM1 AI068636, which supports the ACTG Leadership and Operations Center; and UM1 AI106701, which supports the ACTG Laboratory Center. This work was also supported by the Nutrition Obesity Research Center at Harvard (P30DK040561 to SKG).

Paper cited: Grinspoon, SK*, Zanni MV*,  et al. “Performance of the Pooled Cohorts Equations and D:A:D Risk Scores among Individuals with HIV in a Global Cardiovascular Disease Prevention Trial: A Cohort Study Leveraging Data from REPRIEVE” Lancet HIV DOI: 10.1016/S2352-3018(24)00276-5