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A global study led by Massachusetts General Hospital has uncovered significant discrepancies in how heart disease risks are predicted for people living with HIV (PWH). Despite cardiovascular disease (CVD) being the leading cause of morbidity and mortality worldwide, current prediction models are proving inadequate for certain populations, particularly in low- and middle-income countries (LMICs).
The study, published in Lancet HIV, reveals that existing risk models, such as the atherosclerotic cardiovascular disease (ASCVD) risk scores, often underestimate the cardiovascular risks for women and Black men in high-income countries (HICs) while overestimate the risk for people with HIV in LMICs. This discrepancy highlights a critical gap in understanding how global populations are impacted by cardiovascular events.
The researchers conducted their analysis using data from the Randomized Trial to Prevent Vascular Events in HIV (REPRIEVE), a prospective cohort study that includes participants from HICs, LMICs, and other regions across the globe. The team found that the ASCVD risk scores performed inconsistently across different populations. Specifically, cardiovascular events were underestimated for women and Black men in HICs, which could delay the implementation of necessary preventive measures for these high-risk groups. In contrast, the same models overstated the cardiovascular risks for PWH in LMICs, potentially leading to unnecessary treatment interventions.
Dr. Patrice Desvigne-Nickens, a medical officer at the National Heart, Lung, and Blood Institute (NHLBI), emphasized the importance of these findings, stating, “These findings allow researchers to fine-tune cardiovascular disease prediction models for people living with HIV. 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.”
The study’s co-lead author, Dr. Steven Grinspoon, a chief at the Massachusetts General Hospital Metabolism Unit, echoed this sentiment, stressing the need for more specific and region-tailored cardiovascular disease models. “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,” Grinspoon stated.
The researchers also proposed correction factors to address the underestimation of cardiovascular risk in high-income countries, with the expectation that their findings will influence clinical guidelines. Dr. Markella Zanni, co-lead author and director of Women’s Health Research at Massachusetts General Hospital, suggested that the data might prompt stronger treatment recommendations for women and Black or African American men living with HIV in high-income countries.
This research paves the way for more precise and regionally informed cardiovascular disease prevention strategies for people living with HIV, ultimately improving healthcare outcomes for this vulnerable population globally.
For more details, see the full study: “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” in The Lancet HIV. DOI: 10.1016/S2352-3018(24)00276-5.
