Article Impact Level: HIGH Data Quality: STRONG Summary of The Lancet HIV, S2352301824002765. https://doi.org/10.1016/S2352-3018(24)00276-5 Dr. Steven K. Grinspoon et al.
Points
- The research assessed the accuracy of two ASCVD risk scores, Pooled Cohort Equations (PCE) and D:A:D, for predicting cardiovascular events among people with HIV (PWH) globally using data from 3,893 participants in the REPRIEVE study.
- PCE (C statistic 0.72) and D:A:D (C statistic 0.71) demonstrated moderate predictive performance, with overall good calibration for cardiovascular events.
- The PCE and D:A:D scores overpredict risk in low- and middle-income countries while underpredicting risk in high-income countries, especially for women and Black or African American men.
- PCE risk scores for high-income countries could be improved by subgroup-specific adjustments, such as multiplying the original score by 2.8 for Black or African American women and 2.6 for non-Black women.
- The findings emphasize the necessity of region- and population-specific recalibration of ASCVD risk scores for PWH to enhance accuracy across diverse socioeconomic and demographic contexts.
Summary
This study evaluates the performance of two commonly used atherosclerotic cardiovascular disease (ASCVD) risk scores—Pooled Cohort Equations (PCE) and the D:A:D score—among people with HIV (PWH) globally. The research utilized data from the REPRIEVE study, which included 3,893 PWH participants aged 40-75 years across 12 countries, with data collected from March 2015 to July 2019. The study aimed to assess how well these risk scores predict cardiovascular events in diverse populations, including low-, middle-and high-income countries—traditional cardiovascular risk factors, including hypertension, diabetes, and obesity stratified participants.
The results demonstrated that the PCE risk score had a moderate discrimination performance (C statistic 0.72; 95% CI 0.68-0.76), with good calibration overall (observed-to-expected [OE] event ratio 1.11; p=0.87). However, the model overpredicted risk in low- and middle-income countries and underpredicted risk in high-income countries, particularly for women (OE event ratio 2.39) and Black or African American men (OE event ratio 1.64). A similar pattern was observed for the D:A:D risk score (C statistic 0.71; 95% CI 0.65-0.77). Further analysis indicated that the PCE score’s calibration in high-income countries could be improved by multiplying the original score by specific factors for different subgroups, such as 2.8 for Black or African American women and 2.6 for non-Black women.
In conclusion, the study highlights that the PCE and D:A:D ASCVD risk scores require recalibration for PWH in high-income countries, particularly for women and Black or African American men, as they underpredict cardiovascular events. Additionally, the risk scores overestimate cardiovascular risk in low- and middle-income countries. This study underscores the need for more region- and population-specific models for accurate cardiovascular risk prediction in PWH, particularly in diverse socioeconomic settings.
Link to the article: https://www.thelancet.com/journals/lanhiv/article/PIIS2352-3018(24)00276-5/fulltext
References Grinspoon, S. K., Zanni, M. V., Triant, V. A., Kantor, A., Umbleja, T., Diggs, M. R., Chu, S. M., Fitch, K. V., Currier, J. S., Bloomfield, G. S., Casado, J. L., De La Peña, M., Fantry, L. E., Gardner, E., Aberg, J. A., Malvestutto, C. D., Fichtenbaum, C. J., Lu, M. T., Ribaudo, H. J., & Douglas, P. S. (2025). Performance of the pooled cohort 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. The Lancet HIV, S2352301824002765. https://doi.org/10.1016/S2352-3018(24)00276-5
