Risk Assessment in a Global CVD Prevention Cohort of People With HIV by PCE, PREVENT, and SCORE2.

BACKGROUND: REPRIEVE findings catalyzed changes to multiple guidelines directing statin therapy prescribing for people with HIV (PWH). US guidelines use the pooled cohort equation (PCE)-derived 10-year atherosclerotic cardiovascular disease (ASCVD) risk score but may in the future incorporate the new Predicting Risk of CVD EVENTs (PREVENT) score. Meanwhile, European guidelines use Systematic Coronary Risk Evaluation 2 (SCORE2). METHODS: Leveraging Randomized Trial to Prevent Vascular Events in HIV (REPRIEVE), we compared effects of applying PCE versus either PREVENT according to US guidelines or SCORE2 according to European guidelines among a global primary CVD prevention cohort of PWH. RESULTS: Analysis cohort included 7757 participants with data for PREVENT and SCORE2 calculation. Ten-year ASCVD risk estimates (median [Q1, Q3]) were highest with PCE (4.4% [2.1%, 7.1%]) versus SCORE2 (3.3% [2.0%, 4.9%]) and PREVENT (2.2% [1.3%, 3.3%]). PREVENT- (vs PCE-) based scoring reclassified 38% of participants from a higher to a lower risk group (≥5% to <5%), while SCORE2-based scoring analogously shifted 27% of those age ≥50 years. Among placebo-assigned participants, median observed incidence of hard major adverse cardiovascular events (MACEs)/1000 person-years (PY) was higher than that predicted by PREVENT, except for those with ultralow predicted risk. The estimated cumulative incidence of primary MACE was higher and 5-year number needed to treat (NNT5) lower for most risk groups using PREVENT versus PCE. The NNT5 for the PREVENT-defined risk group of 2.5-5.0% was close to the NNT5 for the PCE-defined risk group of ≥5% (NNT5[95% CI]: 53 [31, 178] vs 47 [30, 109], respectively). CONCLUSIONS: Statin-prescribing guidelines for PWH based on REPRIEVE should account for differences in 10-year ASCVD risk estimates when scores other than PCE are used. FUNDING: National Institutes of Health, Kowa Pharmaceuticals America, Gilead Sciences, and ViiV Healthcare Clinical Trials Registration. REPRIEVE; NCT02344290; https://clinicaltrials.gov/study/NCT02344290.

Duke Scholars

Author Pamela Susan Douglas Medicine, Cardiology

Author Gerald Bloomfield Medicine, Cardiology