To study cardiovascular disease risk score utility we 1) compared the association between Framingham Risk Score (FRS)/pooled cohort equation (PCE) categories and coronary artery plaque presence by HIV serostatus and 2) evaluated whether D:A:D risk category more accurately identifies plaque in HIV-infected men.
Cross-sectional analysis within a substudy of the Multicenter AIDS Cohort Study.
Cardiac CT was performed to assess coronary plaque. We evaluated the association of plaque with increasing CVD risk score category, stratified by HIV serostatus, using logistic regression. ROC 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.
The risk score category-plaque associations were stronger among HIV-uninfected men than HIV-infected men, except for non-calcified plaque. For example, the odds of coronary artery calcium (CAC)>0 were 7.03 (95% CI 4.21, 11.76) times greater among men in the PCE high risk versus low risk category among HIV-uninfected men, compared to just 3.13 (95% CI 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 percent of men with plaque/stenosis, but with lower specificity than D:A:D and FRS. The prevalence of CAC>0 among men in the PCE low risk category was 26.5% (HIV-uninfected men) and 36.0% (HIV-infected men).
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.