Cardiovascular disease (CVD) stands as the number one cause of both illness and death worldwide, especially threatening the health of individuals living with HIV (PWH). To combat this issue, strategies for preventing CVD typically use prediction tools such as atherosclerotic cardiovascular disease (ASCVD) risk scores to gauge the likelihood of heart disease. Nonetheless, earlier research has raised doubts about the effectiveness of these standard prediction tools for individuals with HIV, particularly in low- and middle-income countries (LMICs), where their relevance remains unclear.
Cardiovascular disease (CVD) stands as the number one cause of both illness and death worldwide, particularly threatening the health of individuals living with HIV (PWH). To combat this issue, strategies for preventing CVD typically use prediction tools such as atherosclerotic cardiovascular disease (ASCVD) risk scores to gauge the likelihood of heart disease.
Nonetheless, earlier research has raised doubts about the effectiveness of these standard prediction tools for individuals with HIV, particularly in low- and middle-income countries (LMICs), where their relevance remains unclear.
A team of researchers from Massachusetts General Hospital, part of the Mass General Brigham healthcare system, worked alongside an international group to investigate how well current ASCVD risk assessments can forecast cardiovascular outcomes in diverse global populations with HIV. Their findings are featured in Lancet HIV.
Their study analyzed data from the Randomized Trial to Prevent Vascular Events in HIV (REPRIEVE), focusing on individuals with HIV from various countries across different economic levels. The researchers discovered that the existing risk models underestimated cardiovascular events for women and Black men in high-income countries (HICs) while overestimating risks for all PWH in LMICs.
“These findings enable researchers to refine cardiovascular disease prediction tools for those living with HIV,” stated Patrice Desvigne-Nickens, MD, a medical officer at the National Heart, Lung, and Blood Institute (NHLBI). “By evaluating the precision of these predictions within different population subgroups, we can better target prevention efforts, thanks to extensive outreach and a diverse study cohort that includes all individuals at risk.”
Steven Grinspoon, MD, co-lead author and head of the Massachusetts General Hospital Metabolism Unit in the Department of Medicine, echoed this sentiment. “This research highlights the need for detailed, region-specific, and population-tailored CVD prediction models that accurately represent the cardiovascular risks for PWH, including those in LMICs,” he noted.
“Our team has developed correction factors for the underestimations, and future research is essential to validate these adjustments in other groups. We hope that our results will prompt guideline committees to recognize these issues and potentially advocate for stronger treatment recommendations for women as well as Black or African American men living with HIV in high-income countries,” added co-lead author Markella Zanni, MD, who directs Women’s Health Research in the Metabolism Unit at Massachusetts General Hospital.
