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Cardiovascular disease risk scores’ relationship to subclinical cardiovascular disease among HIV-infected and HIV-uninfected men.

Cardiovascular disease risk scores’ relationship to subclinical cardiovascular disease among HIV-infected and HIV-uninfected men.
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Monroe AK, Haberlen SA, Post WS, Palella FJ, Kinsgley LA, Witt MD, Budoff M, Jacobson LP, Brown TT,


Monroe AK, Haberlen SA, Post WS, Palella FJ, Kinsgley LA, Witt MD, Budoff M, Jacobson LP, Brown TT, (click to view)

Monroe AK, Haberlen SA, Post WS, Palella FJ, Kinsgley LA, Witt MD, Budoff M, Jacobson LP, Brown TT,

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AIDS (London, England) 30(13) 2075-84 doi 10.1097/QAD.0000000000001163

Abstract
OBJECTIVE
To study cardiovascular disease risk score utility, we compared the association between Framingham Risk Score (FRS)/pooled cohort equation (PCE) categories and coronary artery plaque presence by HIV serostatus and evaluated whether D : A : D risk category more accurately identifies plaque in HIV-infected men.

DESIGN
Cross-sectional analysis within a substudy of the Multicenter AIDS Cohort Study.

METHODS
Cardiac computed tomography was performed to assess coronary plaque. We evaluated the association of plaque with increasing cardiovascular disease risk score category, stratified by HIV serostatus, using logistic regression. Receiver operating characteristic curves compared the discrimination of the scores for plaque by HIV serostatus. The sensitivity and specificity of the risk scores were compared in HIV-infected men.

RESULTS
The risk score category – plaque associations were stronger among HIV-uninfected men than HIV-infected men, except for noncalcified plaque. For example, the odds of coronary artery calcium more than 0 were 7.03 (95% confidence interval 4.21, 11.76) times greater among men in the PCE high-risk versus low-risk category among HIV-uninfected men, compared with just 3.13 (95% confidence interval 2.13, 4.61) times greater among men in the high-risk versus low-risk category among HIV-infected men. Among HIV-infected men, high-risk category by PCE identified the greatest percentage of men with plaque/stenosis, but with lower specificity than D : A : D and FRS. The prevalence of coronary artery calcium more than 0 among men in the PCE low-risk category was 26.5% (HIV-uninfected men) and 36.0% (HIV-infected men).

CONCLUSIONS
FRS and PCE categories associate with plaque burden better in HIV-uninfected men. No risk score delivered both high sensitivity and specificity among HIV-infected men.

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