Abstract 17992: Observed versus Predicted Myocardial Infarction Among Individuals With Human Immunodeficiency Virus by American College of Cardiology/American Heart Association Pooled Cohort Equation Risk Strata: Center for AIDS Research Network of Integrated Clinical Systems

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Matthew J Feinstein ◽  
Daniel R Drozd ◽  
Hongyan Ning ◽  
Joseph A Delaney ◽  
Robin Nance ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Human Immunodeficiency Virus ◽  
Risk Prediction ◽  
White Men ◽  
Cvd Risk ◽  
Immunodeficiency Virus ◽  
Ascvd Risk ◽  
Risk Estimator ◽  
Aids Research ◽  
Clinical Systems

Background: Human immunodeficiency virus (HIV)-infected individuals are at elevated risk for cardiovascular disease (CVD) due to an interplay between traditional CVD risk factors, chronic inflammation persisting despite HIV viral suppression, and side effects of antiretroviral therapy. Previous studies evaluating CVD risk prediction models in HIV populations have generally been small in size and assessed non-U.S. cohorts. The 2013 ACC/AHA ASCVD Risk Estimator has not been evaluated in a large, multi-center HIV cohort. Hypothesis: Our primary hypothesis was that the ACC/AHA ASCVD Risk Estimator would underestimate ASCVD risk across risk strata for HIV-infected patients. Methods: We evaluated this risk prediction tool in the Centers for AIDS Research (CFAR) Network of Integrated Clinical Systems (CNICS) multi-center U.S.-based cohort of approximately 30,000 HIV-infected adults with rigorous central adjudication of myocardial infarction (MI) and differentiation between type I and II MI. We compared MI and ASCVD risks predicted by the ASCVD Risk Estimator to actual rates of MI observed in the CNICS cohort. Results: A total of 132 MIs were observed during follow-up, compared with 103 MIs that would have been expected based on the ASCVD risk estimator. Observed MI rates were higher than expected across most predicted risk levels, particularly among black participants and those with low (<5%) predicted 10-year ASCVD risk. This under-prediction was relatively uniform across risk strata among white men; the observed MI rates were 68%, 68%, 67%, and 67% greater than expected, respectively, for white men with <5%, 5% to <7.5%, 7.5% to <10%, and 10% or greater predicted 10-year ASCVD risk. Conclusions: These data suggest that the ACC/AHA Risk Estimator under-predicts MI risk among HIV-infected individuals. The under-prediction was relatively uniform across risk strata for white men. These data highlight the need for accurate HIV-specific CVD risk prediction tools.

scholarly journals Aspartame Intake Relates to Coronary Plaque Burden and Inflammatory Indices in Human Immunodeficiency Virus

2017 ◽  
Vol 4 (2) ◽  
Author(s):  
Leangelo N. Hall ◽  
Laura R. Sanchez ◽  
Jane Hubbard ◽  
Hang Lee ◽  
Sara E. Looby ◽  
...  
Keyword(s):  
Human Immunodeficiency Virus ◽  
Cardiac Computed Tomography ◽  
Coronary Plaque ◽  
Plaque Burden ◽  
Artificial Sweetener ◽  
Food Record ◽  
Cvd Risk ◽  
Cardiac Computed Tomography Angiography ◽  
Markers Of Inflammation ◽  
Immunodeficiency Virus

Abstract Background Dietary sweeteners may contribute to metabolic dysregulation and cardiovascular disease (CVD), but this has not been assessed in human immunodeficiency virus (HIV). Methods One hundred twenty-four HIV-infected and 56 non-HIV-infected participants, without history of known coronary artery disease were included. Dietary intake was assessed using a 4-day food record. Coronary plaque was determined using cardiac computed tomography angiography. Results Human immunodeficiency virus-infected participants had significantly greater intake of dietary sweeteners, including total sugar (P = .03) and added sugar (P = .009); intake of aspartame (artificial sweetener) was greater among aspartame consumers with HIV versus non-HIV consumers (P = .03). Among HIV-infected participants, aspartame intake was significantly associated with coronary plaque (P = .002) and noncalcified plaque (P = .007) segments, as well as markers of inflammation/immune activation (monocyte chemoattractant protein 1 and lipoprotein-associated phospholipase A2), which may contribute to increased atherogenesis. In multivariable regression modeling, aspartame remained an independent predictor of plaque in HIV. In contrast, among non-HIV-infected participants, no sweetener type was shown to relate to plaque characteristics. Conclusions We demonstrate increased intake of dietary sweeteners and a potential novel association between aspartame intake, plaque burden, and inflammation in HIV. Our data suggest that aspartame may contribute to CVD risk in HIV. Further studies should address potential mechanisms by which aspartame may contribute to increased plaque burden and cardiovascular benefits of dietary strategies targeting aspartame intake in HIV.

Cardiovascular Risk Based on ASCVD and KDIGO Categories in Chinese Adults: A Nationwide, Population-Based, Prospective Cohort Study

2021 ◽  
pp. ASN.2020060856
Author(s):  
Yu Xu ◽  
Mian Li ◽  
Guijun Qin ◽  
Jieli Lu ◽  
Li Yan ◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
Cohort Study ◽  
Risk Prediction ◽  
Cox Regression ◽  
Rank Test ◽  
Atherosclerotic Cardiovascular Disease ◽  
Cvd Risk ◽  
Cox Regression Analysis ◽  
Ascvd Risk ◽  
Risk Categories

BackgroundThe Kidney Disease Improving Global Outcomes (KDIGO) clinical practice guideline used eGFR and urinary albumin-creatinine ratio (ACR) to categorize risks for CKD prognosis. The utility of KDIGO’s stratification of major CVD risks and predictive ability beyond traditional CVD risk prediction scores are unknown.MethodsTo evaluate CVD risks on the basis of ACR and eGFR (individually, together, and in combination using the KDIGO risk categories) and with the atherosclerotic cardiovascular disease (ASCVD) score, we studied 115,366 participants in the China Cardiometabolic Disease and Cancer Cohort study. Participants (aged ≥40 years and without a history of cardiovascular disease) were examined prospectively for major CVD events, including nonfatal myocardial infarction, nonfatal stroke, and cardiovascular death.ResultsDuring 415,111 person-years of follow-up, 2866 major CVD events occurred. Incidence rates and multivariable-adjusted hazard ratios of CVD events increased significantly across the KDIGO risk categories in ASCVD risk strata (all P values for log-rank test and most P values for trend in Cox regression analysis <0.01). Increases in c statistic for CVD risk prediction were 0.01 (0.01 to 0.02) in the overall study population and 0.03 (0.01 to 0.04) in participants with diabetes, after adding eGFR and log(ACR) to a model including the ASCVD risk score. In addition, adding eGFR and log(ACR) to a model with the ASCVD score resulted in significantly improved reclassification of CVD risks (net reclassification improvements, 4.78%; 95% confidence interval, 3.03% to 6.41%).ConclusionsUrinary ACR and eGFR (individually, together, and in combination using KDIGO risk categories) may be important nontraditional risk factors in stratifying and predicting major CVD events in the Chinese population.

scholarly journals Baseline 10-Year Cardiovascular Risk Scores Predict Cognitive Function in Older Persons, and Particularly Women, Living With Human Immunodeficiency Virus Infection

2020 ◽  
Author(s):  
Felicia C Chow ◽  
Asya Lyass ◽  
Taylor F Mahoney ◽  
Joseph M Massaro ◽  
Virginia A Triant ◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
Human Immunodeficiency Virus ◽  
Cardiovascular Risk ◽  
Cognitive Function ◽  
Risk Score ◽  
Risk Scores ◽  
Atherosclerotic Cardiovascular Disease ◽  
Composite Effect ◽  
Immunodeficiency Virus ◽  
Ascvd Risk

Abstract Background Cardiovascular disease (CVD) and associated comorbidities increase the risk of cognitive impairment in persons living with human immunodeficiency virus (PLWH). Given the potential composite effect of multiple cardiovascular risk factors on cognition, we examined the ability of the Atherosclerotic Cardiovascular Disease (ASCVD) risk score and the Framingham Heart Study Global CVD risk score (FRS) to predict future cognitive function in older PLWH. Methods We constructed linear regression models evaluating the association between baseline 10-year cardiovascular risk scores and cognitive function (measured by a summary z-score, the NPZ-4) at a year 4 follow-up visit. Results Among 988 participants (mean age, 52 years; 20% women), mean 10-year ASCVD risk score at entry into the cohort was 6.8% (standard deviation [SD], 7.1%) and FRS was 13.1% (SD, 10.7%). In models adjusted only for cognitive function at entry, the ASCVD risk score significantly predicted year 4 NPZ-4 in the entire cohort and after stratification by sex (for every 1% higher ASCVD risk, year 4 NPZ-4 was lower by 0.84 [SD, 0.28] overall, P = .003; lower by 2.17 [SD, 0.67] in women, P = .001; lower by 0.78 [SD, 0.32] in men, P = .016). A similar relationship was observed between FRS and year 4 NPZ-4. In multivariable models, higher 10-year ASCVD risk and FRS predicted lower NPZ-4 in women. Conclusions Baseline 10-year ASCVD risk and FRS predicted future cognitive function in older PLWH with well-controlled infection. Cardiovascular risk scores may help to identify PLWH, especially women, who are at risk for worse cognition over time.

scholarly journals CD8+T-Cells Count in Acute Myocardial Infarction in HIV Disease in a Predominantly Male Cohort

2015 ◽  
Vol 2015 ◽  
pp. 1-5 ◽  
Author(s):  
Oluwatosin A. Badejo ◽  
Chung-Chou Chang ◽  
Kaku A. So-Armah ◽  
Russell P. Tracy ◽  
Jason V. Baker ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
T Cell ◽  
Cell Count ◽  
Hiv Viral Load ◽  
Cvd Risk ◽  
Infected People ◽  
Cell Counts ◽  
Immunodeficiency Virus ◽  
Male Cohort

Human Immunodeficiency Virus- (HIV-) infected persons have a higher risk for acute myocardial infarction (AMI) than HIV-uninfected persons. Earlier studies suggest that HIV viral load, CD4+T-cell count, and antiretroviral therapy are associated with cardiovascular disease (CVD) risk. Whether CD8+T-cell count is associated with CVD risk is not clear. We investigated the association between CD8+T-cell count and incident AMI in a cohort of 73,398 people (of which 97.3% were men) enrolled in the U.S. Veterans Aging Cohort Study-Virtual Cohort (VACS-VC). Compared to uninfected people, HIV-infected people with high baseline CD8+T-cell counts (>1065 cells/mm3) had increased AMI risk (adjustedHR=1.82, P<0.001, 95% CI: 1.46 to 2.28). There was evidence that the effect of CD8+T-cell tertiles on AMI risk differed by CD4+T-cell level: compared to uninfected people, HIV-infected people with CD4+T-cell counts ≥200 cells/mm3had increased AMI risk with high CD8+T-cell count, while those with CD4+T-cell counts <200 cells/mm3had increased AMI risk with low CD8+T-cell count. CD8+T-cell counts may add additional AMI risk stratification information beyond that provided by CD4+T-cell counts alone.

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