Tahir Irtiza S, Vos Alinda G, Damen Johanna A A, Barth Roos E, Tempelman Hugo A, Grobbee Diederick E, Scheuermaier Karine, Venter Willem D F, Klipstein-Grobusch Kerstin
Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands.
Ezintsha, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
South Afr J HIV Med. 2022 Nov 15;23(1):1395. doi: 10.4102/sajhivmed.v23i1.1395. eCollection 2022.
Current cardiovascular risk assessment in people living with HIV is based on general risk assessment tools; however, whether these tools can be applied in sub-Saharan African populations has been questioned.
The study aimed to assess cardiovascular risk classification of common cardiovascular disease (CVD) risk prediction models compared to the Data Collection on Adverse Events of Anti-HIV Drugs (D:A:D) 2010 and 2016 models in people living with HIV.
Cardiovascular disease risk was estimated by Framingham Cardiovascular and Heart Disease (FHS-CVD, FHS-CHD), Atherosclerotic Cardiovascular Disease (ASCVD) and D:A:D 2010 and 2016 risk prediction models for HIV-infected participants of the Ndlovu Cohort Study, Limpopo, rural South Africa. Participants were classified to be at low (< 10%), moderate (10% - 20%), or high-risk (> 20%) of CVD within 10 years for general CVD and five years for D:A:D models. Kappa statistics were used to determine agreement between CVD risk prediction models. Subgroup analysis was performed according to age.
The analysis comprised 735 HIV-infected individuals, predominantly women (56.7%), average age 43.9 (8.8) years. The median predicted CVD risk for D:A:D 2010 and FHS-CVD was 4% and for ASCVD and FHS-CHD models, 3%. For the D:A:D 2016 risk prediction model, the figure was 5%. High 10-year CVD risk was predicted for 2.9%, 0.5%, 0.7%, 3.1% and 6.6% of the study participants by FHS-CVD, FHS-CHD, ASCVD, and D:A:D 2010 and 2016. Kappa statistics ranged from 0.34 for ASCVD to 0.60 for FHS-CVD as compared to the D:A:D 2010 risk prediction model.
Overall, predicted CVD risk is low in this population. Compared to D:A:D 2010, CVD risk estimated by the FHS-CVD model showed similar overall results for risk classification. With the exception of the D:A:D model, all other risk prediction models classified fewer people to be at high estimated CVD risk. Prospective studies are needed to develop and validate CVD risk algorithms in people living with HIV in sub-Saharan Africa.
目前对感染艾滋病毒者的心血管疾病风险评估是基于一般风险评估工具；然而，这些工具是否适用于撒哈拉以南非洲人群一直受到质疑。
本研究旨在评估常见心血管疾病（CVD）风险预测模型与抗逆转录病毒药物不良事件数据收集（D:A:D）2010年和2016年模型相比，在感染艾滋病毒者中的心血管疾病风险分类情况。
通过弗雷明汉心血管疾病和心脏病（FHS-CVD、FHS-CHD）、动脉粥样硬化性心血管疾病（ASCVD）以及D:A:D 2010年和2016年风险预测模型，对南非林波波省农村地区恩德洛武队列研究中的艾滋病毒感染参与者的心血管疾病风险进行评估。参与者被分类为在未来10年内患一般心血管疾病的低风险（<10%）、中度风险（10% - 20%）或高风险（>20%），以及在未来5年内患D:A:D模型所定义疾病的相应风险类别。卡方统计用于确定心血管疾病风险预测模型之间的一致性。根据年龄进行亚组分析。
分析包括735名艾滋病毒感染者，主要为女性（56.7%），平均年龄43.9（8.8）岁。D:A:D 2010年模型和FHS-CVD模型预测的心血管疾病风险中位数为4%，ASCVD模型和FHS-CHD模型为3%。D:A:D 2016年风险预测模型的这一数字为5%。FHS-CVD、FHS-CHD、ASCVD、D:A:D 2010年和2016年模型预测，研究参与者中10年心血管疾病高风险者分别为2.9%、0.5%、0.7%、3.1%和6.6%。与D:A:D 2010年风险预测模型相比，卡方统计值范围从ASCVD模型的0.34到FHS-CVD模型的0.60。
总体而言，该人群预测的心血管疾病风险较低。与D:A:D 2010年模型相比，FHS-CVD模型估计的心血管疾病风险在风险分类方面显示出相似的总体结果。除D:A:D模型外，所有其他风险预测模型将估计心血管疾病高风险的人数分类得更少。需要进行前瞻性研究，以开发和验证撒哈拉以南非洲艾滋病毒感染者的心血管疾病风险算法。
