@article{1ea3358e34a84ae8a4f73ef5fbcbf7e3,
title = "Predictive Performance of Cardiovascular Disease Risk Prediction Algorithms in People Living With HIV",
abstract = "Background: People living with HIV (PLWH) experience a higher cardiovascular disease (CVD) risk. Yet, traditional algorithms are often used to estimate CVD risk. We evaluated the performance of 4 commonly used algorithms.Setting: The Netherlands.Methods: We used data from 16,070 PLWH aged > 18 years, who were in care between 2000 and 2016, had no pre-existing CVD, had initiated first combination antiretroviral therapy >1 year ago, and had available data on CD4 count, smoking status, cholesterol, and blood pressure. Predictive performance of 4 algorithms [Data Collection on Adverse Effects of Anti-HIV Drugs Study (D: A: D); Systematic COronary Risk Evaluation adjusted for national data (SCORE-NL); Framingham CVD Risk Score (FRS); and American College of Cardiology and American Heart Association Pooled Cohort Equations (PCE)] was evaluated using a Kaplan-Meier approach. Model discrimination was assessed using Harrell's C-statistic. Calibration was assessed using observed-versusexpected ratios, calibration plots, and Greenwood-Nam-D'Agostino goodness-of-fit tests.Results: All algorithms showed acceptable discrimination (Harrell's C-statistic 0.73-0.79). On a population level, D: A: D, SCORE-NL, and PCE slightly underestimated, whereas FRS slightly overestimated CVD risk (observed-versus-expected ratios 1.35, 1.38, 1.14, and 0.92, respectively). D: A: D, FRS, and PCE best fitted our data but still yielded a statistically significant lack of fit (Greenwood-Nam-D'Agostino chi(2) ranged from 24.57 to 34.22, P <0.05). Underestimation of CVD risk was particularly observed in low-predicted CVD risk groups.Conclusions: All algorithms perform reasonably well in PLWH, with SCORE-NL performing poorest. Prediction algorithms are useful for clinical practice, but clinicians should be aware of their limitations (ie, lack of fit and slight underestimation of CVD risk in low-risk groups).",
keywords = "DATA-COLLECTION, EVENTS, FRAMINGHAM, HEART-DISEASE, HIV, HUMAN-IMMUNODEFICIENCY-VIRUS, INFECTED PATIENTS, INFLAMMATION, MYOCARDIAL-INFARCTION, SCORE, SUBCLINICAL ATHEROSCLEROSIS, cardiovascular disease, risk prediction algorithms, CARDIOLOGY/AMERICAN HEART ASSOCIATION, AMERICAN-COLLEGE",
author = "{van Zoest}, {Rosan A.} and Matthew Law and Sabin, {Caroline A.} and Ilonca Vaartjes and {Van der Valk}, Marc and Arends, {Joop E.} and Peter Reiss and Wit, {Ferdinand W.} and Geerlings, {S. E.} and Godfried, {M. H.} and A. Goorhuis and Hovius, {J. W.} and Kuijpers, {T. W.} and Nellen, {F. J. B.} and {van der Poll}, {D. T.} and Prins, {J. M.} and {van Vugt}, {H. J. M.} and Wiersinga, {W. J.} and Wit, {F. W. M. N.} and {van Duinen}, M. and Cornelissen, {M. T. E.} and Peters, {E. J. G.} and M. Groot and A. Verbon and {van Beek}, {J. E. A.} and {de Groot}, J. and {de Boer}, {M. G. J.} and Smit, {J. V.} and E. Smit and Lowe, {S. H.} and Lashof, {A. M. L. Oude} and D. Posthouwer and Ackens, {R. P.} and K. Burgers and J. Schippers and {van Loo}, {I. H. M.} and Havenith, {T. R. A.} and Smits, {P. H. M.} and S. Weijer and Kootstra, {G. J.} and R. Jansen and Brouwer, {C. J.} and {van der Ven}, {A. J. A. M.} and {de Haan}, M. and {van Wijk}, M. and M. Bakker and {de Jong}, A. and {van den Akker}, M. and {van der Meer}, R. and {ATHENA National Observational HIV Cohort}",
note = "Funding Information: The ATHENA cohort is managed by Stichting HIV Monitoring and supported by a grant from the Dutch Ministry of Health, Welfare and Sport through the Centre for Infectious Disease Control of the National Institute for Public Health and the Environment. Funding Information: R.A.v.Z. has received travel grants from Gilead Sciences and speaker fees from Gilead Sciences and Janssen-Cilag for which her institution received remuneration. M.L. reports unrestricted grants from Boehringer Ingelheim, Gilead Sciences, Merck Sharp & Dohme, Bristol-Myers Squibb, Janssen-Cilag, ViiV HealthCare, and consultancy and presentation fees from Gilead Sciences. C.A.S. has received funding for participation in Advisory Boards, for membership of Data Safety and Monitoring Committees, and for the preparation of educational materials from Gilead Sciences, ViiV Healthcare and Janssen- Cilag. M.v.d.V. reports personal fees from Abbvie, BMS, Gilead Sciences, ViiV Healthcare, Merck, and Janssen outside the submitted work. J.E.A. reports institutional fees from Gilead Sciences, ViiV Healthcare, Abbvie, Janssen, and Merck; institutional (research) grants from Merck, Abbvie, BMS, and Jansen. P.R. reports independent scientific grant support outside the submitted work from Gilead Sciences, Janssen Pharmaceuticals Inc, Merck & Co, Bristol-Myers Squibb and ViiV Healthcare (through his institution); he has served on scientific advisory board for Gilead Sciences, ViiV Healthcare, Merck & Co and Teva Pharmaceutical Industries and on a Data Safety Monitoring Committee for Janssen Pharmaceuticals Inc (all honoraria paid to institution). F.W.W. has received consultation and speaker fees from Gilead Sciences and ViiV Healthcare. The remaining author has no conflicts of interest to disclose. Publisher Copyright: Copyright {\textcopyright} 2019 Wolters Kluwer Health, Inc. All rights reserved.",
year = "2019",
month = aug,
day = "15",
doi = "10.1097/QAI.0000000000002069",
language = "English",
volume = "81",
pages = "562--571",
journal = "Jaids-journal of Acquired Immune Deficiency Syndromes",
issn = "1525-4135",
publisher = "LIPPINCOTT WILLIAMS & WILKINS",
number = "5",
}