撒哈拉以南非洲地区艾滋病毒感染患者中，美国心脏病学会（ACC）/美国心脏协会（AHA）动脉粥样硬化性心血管疾病（ASCVD）风险评分对心血管疾病的风险预测。
Cardiovascular disease risk prediction by the American College of Cardiology (ACC)/American Heart Association (AHA) Atherosclerotic Cardiovascular Disease (ASCVD) risk score among HIV-infected patients in sub-Saharan Africa.
作者信息
Mosepele Mosepele, Hemphill Linda C, Palai Tommy, Nkele Isaac, Bennett Kara, Lockman Shahin, Triant Virginia A
机构信息
Department of Medicine, Faculty of Medicine, University of Botswana, Gaborone, Botswana.
The Heart Center, Division of Cardiology, Massachusetts General Hospital & Harvard Medical School, Boston, Massachusetts, United States of America.
出版信息
PLoS One. 2017 Feb 24;12(2):e0172897. doi: 10.1371/journal.pone.0172897. eCollection 2017.
OBJECTIVES
HIV-infected patients are at increased risk for cardiovascular disease (CVD). However, general population CVD risk prediction equations that identify HIV-infected patients at elevated risk have not been widely assessed in sub-Saharan African (SSA).
METHODS
HIV-infected adults from 30-50 years of age with documented viral suppression were enrolled into a cross-sectional study in Gaborone, Botswana. Participants were screened for CVD risk factors. Bilateral carotid intima-media thickness (cIMT) was measured and 10-year predicted risk of cardiovascular disease was calculated using the Pooled Cohorts Equation for atherosclerotic CVD (ASCVD) and the 2008 Framingham Risk Score (FRS) (National Cholesterol Education Program III-NCEP III). ASCVD ≥7.5%, FRS ≥10%, and cIMT≥75th percentile were considered elevated risk for CVD. Agreement in classification of participants as high-risk for CVD by cIMT and FRS or ASCVD risk score was assessed using McNemar`s Test. The optimal cIMT cut off-point that matched ASCVD predicted risk of ≥7.5% was assessed using Youden's J index.
RESULTS
Among 208 HIV-infected patients (female: 55%, mean age 38 years), 78 (38%) met criteria for ASCVD calculation versus 130 (62%) who did not meet the criteria. ASCVD classified more participants as having elevated CVD risk than FRS (14.1% versus 2.6%, McNemar's exact test p = 0.01), while also classifying similar proportion of participants as having elevated CVD like cIMT (14.1% versus 19.2%, McNemar's exact test p = 0.34). Youden's J calculated the optimal cut point at the 81st percentile for cIMT to correspond to an ASCVD score ≥7.5% (sensitivity = 72.7% and specificity = 88.1% with area under the curve for the receiver operating characteristic [AUC] of 0.82, 95% Mann-Whitney CI: 0.66-0.99).
CONCLUSION
While the ASCVD risk score classified more patients at elevated CVD risk than FRS, ASCVD score classified similar proportion of patients as high risk when compared with established subclinical atherosclerosis. However, potential CVD risk category misclassification by established equations such as ASCVD may still exist among HIV-infected patients; hence there is still a need for development of a CVD risk prediction equation tailored to HIV-infected patients in SSA.
目的
HIV感染患者患心血管疾病（CVD）的风险增加。然而，用于识别CVD风险升高的HIV感染患者的一般人群CVD风险预测方程在撒哈拉以南非洲（SSA）尚未得到广泛评估。
方法
年龄在30至50岁、有病毒抑制记录的HIV感染成人被纳入博茨瓦纳哈博罗内的一项横断面研究。对参与者进行CVD风险因素筛查。测量双侧颈动脉内膜中层厚度（cIMT），并使用动脉粥样硬化性CVD（ASCVD）的合并队列方程和2008年弗雷明汉风险评分（FRS）（国家胆固醇教育计划III-NCEP III）计算10年心血管疾病预测风险。ASCVD≥7.5%、FRS≥10%和cIMT≥第75百分位数被视为CVD风险升高。使用McNemar检验评估通过cIMT和FRS或ASCVD风险评分将参与者分类为CVD高风险的一致性。使用约登指数评估与ASCVD预测风险≥7.5%相匹配的最佳cIMT切点。
结果
在208名HIV感染患者中（女性：55%，平均年龄38岁），78名（38%）符合ASCVD计算标准，130名（62%）不符合标准。与FRS相比，ASCVD将更多参与者分类为CVD风险升高（14.1%对2.6%，McNemar精确检验p = 0.01），同时与cIMT一样将相似比例的参与者分类为CVD风险升高（14.1%对19.2%，McNemar精确检验p = 0.34）。约登指数计算出cIMT第81百分位数的最佳切点对应于ASCVD评分≥7.5%（敏感性 = 72.7%，特异性 = 88.1%，受试者工作特征曲线下面积[AUC]为0.82，95%曼-惠特尼CI：0.66 - 0.99）。
结论
虽然ASCVD风险评分比FRS将更多患者分类为CVD风险升高，但与已确定的亚临床动脉粥样硬化相比，ASCVD评分将相似比例的患者分类为高风险。然而，在HIV感染患者中，ASCVD等既定方程可能仍存在潜在CVD风险类别错误分类的情况；因此，仍然需要开发一种针对SSA地区HIV感染患者的CVD风险预测方程。
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