Study: MI Risk Models Inadequate for Predicting Risk in HIV Patients

A recently published study from Northwestern University tested the effectiveness of the Pooled Cohort Equations (PCEs) developed by the American College of Cardiology and American Heart Association for 10-year atherosclerotic cardiovascular disease risk (ASCVD) prediction, and developed 2 other risk assessments (HIVMI-1 and HIVMI-2) in an effort to improve the Pooled Cohort Equations.

The study included data on 19,829 HIV-infected adults from 5 Center for AIDS Research Network of Integrated Clinical Systems sites who received care since 1995 to assess the effectiveness of PCEs and to test the two new risk assessment models.
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The PCEs performed adequately for the entire cohort, and had a high calibration for assessing the risks in white men, but performed poorly for black men and women, and white women. The HIVMI-1 and HIVMI-2 models developed by researchers had worse calibration for predicting MI and performed poorly compared to the PCEs.

Their results for the PCEs may be useful for clinicians to determine a baseline for what the patient’s lowest predicted atherosclerotic cardiovascular disease risks are. “For instance, if an HIV⁺ patient’s predicted 10-year ASCVD risk is 8%, our findings suggest that the patient’s “true” risk is at least 8% and perhaps greater. This risk of at least 8% could guide clinician-patient consideration of cardiovascular disease–preventive therapy,” the researchers stated.

While PCEs were not effective for all participants, and still need to be improved, researchers did find that the PCEs performed well in assessing risks for white men, and may be useful in a clinical setting to determine what the best preventative measures are for a patient.

—Melissa Weiss

Reference:

Feinstein MJ, Nance RM, Drozd DR, et al. Assessing and refining myocardial infarction risk estimation among patients with human immunodeficiency virus: a study by the Center for AIDS Research Network of integrated clinical systems [published online December 21, 2016]. JAMA Cardiology. doi:10.1001/jamacardio.2016.4494