Current risk models underestimate cardiovascular events in both women and black men in high income countries (HICs), while overestimating cardiovascular events for all PWH in LMICs
A team of US researchers has found that
for people with HIV, current risk models underestimated cardiovascular events
in both women and black men in high-income countries.
Cardiovascular disease is the leading
cause of morbidity and mortality globally, posing a particularly significant
threat to people with HIV (PWH), according to new study published in the journal
Lancet HIV.
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 atherosclerotic cardiovascular disease (ASCVD) risk
estimates could be used to predict cardiovascular outcomes in global
populations with HIV.
Their prospective cohort 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.
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, 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,” Desvigne-Nickens
added.
According to Steven Grinspoon, chief of
the Massachusetts General Hospital Metabolism Unit in the Endocrinology
Division of the Department of Medicine, 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.
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