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Diagnosis of subclinical atherosclerosis in HIV-infected patients: higher accuracy of the D:A:D risk equation over Framingham and SCORE algorithms
Abstract Aims While the detection of subclinical atherosclerosis may provide an opportunity for the prevention of cardiovascular disease (CVD), which currently is a leading cause of death in HIV-infected subjects, its diagnosis is a clinical challenge. We aimed to compare the agreement and diagnosti...
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| Published in: | European journal of preventive cardiology 2014-06, Vol.21 (6), p.739-748 |
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| container_title | European journal of preventive cardiology |
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| creator | Serrano-Villar, Sergio Estrada, Vicente Gómez-Garre, Dulcenombre Ávila, Mario Fuentes-Ferrer, Manuel San, Román Jesús Soriano, Vicente Sánchez-Parra, Clara Sainz, Talía Fernández-Cruz, Arturo |
| description | Abstract
Aims
While the detection of subclinical atherosclerosis may provide an opportunity for the prevention of cardiovascular disease (CVD), which currently is a leading cause of death in HIV-infected subjects, its diagnosis is a clinical challenge. We aimed to compare the agreement and diagnostic performance of Framingham, SCORE and D:A:D equations for the recognition of subclinical atherosclerosis in HIV patients and to adjust the D:A:D equation using HIV and CVD variables.
Methods and results
Atherosclerosis was evaluated in 203 HIV-infected individuals by measuring the carotid intima-media thickness (IMT). The CVD risk was calculated using the Framingham, SCORE and D:A:D risk equations. Framingham, SCORE and D:A:D equations showed a low agreement with the IMT (Kappa: 0.219, 0.298, 0.244, respectively; p = 0.743) and a moderate predictive performance, (area under the curve [AUC] = 0.686, 0.665 and 0.716, respectively; p = 0.048), with the D:A:D equation being the most accurate. Atherosclerosis was demonstrated in a significant proportion of subjects with low predicted CVD risk by all three algorithms (16.3%, 17.2%, 17.2%, respectively; p = 0.743). In patients with an estimated low CVD risk atherosclerosis was associated with older age (p = 0.012) and low CD4 counts (p = 0.021). A model was developed to adjust the D:A:D equation; a significant increase in accuracy was obtained when CD4 counts and low-grade albuminuria were included (AUC = 0.772; p |
| doi_str_mv | 10.1177/2047487312452964 |
| format | article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_1668241008</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><oup_id>10.1177/2047487312452964</oup_id><sage_id>10.1177_2047487312452964</sage_id><sourcerecordid>1668241008</sourcerecordid><originalsourceid>FETCH-LOGICAL-c445t-f0a50cc0f25a0d1453e09e0e07817b9d37e9f4edd5f447b4b5aa698dab9c6bca3</originalsourceid><addsrcrecordid>eNqFkV1L5DAUhsPiouJ675XkRhCkbpKmTTp3MuMXCIL7cVtO06QTbZMxaRf8G_uLzTCjC3uhuUjCyfO-ObwHoSNKzikV4jsjXHApcsp4waqSf0H761LGpaQ773eR76HDGB9JWiVhTMpdtMeYoFJUch_9XVjonI82Ym9wnBrVW2cV9BjGpQ4-qn69p2fr8M3t78w6o9WoW7yC0Wo3xhle2i6hGJSaAqiXtVHS4sXsYrbAwcYnrJ-nRHuH_Z8EXgUYrOuWMGBwLf4xv3-4xNB3PthxOcRv6KuBPurD7XmAfl1d_pzfZHf317fzi7tMcV6MmSFQEKWIYQWQlvIi16TSRBMhqWiqNhe6Mly3bWE4Fw1vCoCyki00lSobBfkBOt34roJ_nnQc68FGpfsenPZTrGlZSsYpITKhZIOqlEUM2tSrYAcILzUl9XoY9f_DSJLjrfvUDLp9F7xFn4CTLQAx5W0COGXjP06WQrAqT1y24SJ0un70U3AplY8-Ptvwflp93uYrNXysLA</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1668241008</pqid></control><display><type>article</type><title>Diagnosis of subclinical atherosclerosis in HIV-infected patients: higher accuracy of the D:A:D risk equation over Framingham and SCORE algorithms</title><source>Oxford Journals Online</source><creator>Serrano-Villar, Sergio ; Estrada, Vicente ; Gómez-Garre, Dulcenombre ; Ávila, Mario ; Fuentes-Ferrer, Manuel ; San, Román Jesús ; Soriano, Vicente ; Sánchez-Parra, Clara ; Sainz, Talía ; Fernández-Cruz, Arturo</creator><creatorcontrib>Serrano-Villar, Sergio ; Estrada, Vicente ; Gómez-Garre, Dulcenombre ; Ávila, Mario ; Fuentes-Ferrer, Manuel ; San, Román Jesús ; Soriano, Vicente ; Sánchez-Parra, Clara ; Sainz, Talía ; Fernández-Cruz, Arturo</creatorcontrib><description>Abstract
Aims
While the detection of subclinical atherosclerosis may provide an opportunity for the prevention of cardiovascular disease (CVD), which currently is a leading cause of death in HIV-infected subjects, its diagnosis is a clinical challenge. We aimed to compare the agreement and diagnostic performance of Framingham, SCORE and D:A:D equations for the recognition of subclinical atherosclerosis in HIV patients and to adjust the D:A:D equation using HIV and CVD variables.
Methods and results
Atherosclerosis was evaluated in 203 HIV-infected individuals by measuring the carotid intima-media thickness (IMT). The CVD risk was calculated using the Framingham, SCORE and D:A:D risk equations. Framingham, SCORE and D:A:D equations showed a low agreement with the IMT (Kappa: 0.219, 0.298, 0.244, respectively; p = 0.743) and a moderate predictive performance, (area under the curve [AUC] = 0.686, 0.665 and 0.716, respectively; p = 0.048), with the D:A:D equation being the most accurate. Atherosclerosis was demonstrated in a significant proportion of subjects with low predicted CVD risk by all three algorithms (16.3%, 17.2%, 17.2%, respectively; p = 0.743). In patients with an estimated low CVD risk atherosclerosis was associated with older age (p = 0.012) and low CD4 counts (p = 0.021). A model was developed to adjust the D:A:D equation; a significant increase in accuracy was obtained when CD4 counts and low-grade albuminuria were included (AUC = 0.772; p < 0.001).
Conclusion
The D:A:D equation overperforms Framingham and SCORE in HIV patients. However, all three equations underestimate the presence of subclinical atherosclerosis in this population. The accuracy of the D:A:D equation improves when CD4 counts and low-grade albuminuria are incorporated into the equation.</description><identifier>ISSN: 2047-4873</identifier><identifier>EISSN: 2047-4881</identifier><identifier>DOI: 10.1177/2047487312452964</identifier><identifier>PMID: 22718798</identifier><language>eng</language><publisher>London, England: Oxford University Press</publisher><subject>Adult ; Aged ; Albuminuria - diagnosis ; Algorithms ; Atherosclerosis (general aspects, experimental research) ; Atherosclerosis - diagnosis ; Atherosclerosis - etiology ; Biological and medical sciences ; Blood and lymphatic vessels ; Cardiology. Vascular system ; Carotid Intima-Media Thickness ; CD4 Lymphocyte Count ; Cross-Sectional Studies ; Female ; Heart ; HIV Infections - complications ; Human viral diseases ; Humans ; Immunodeficiencies ; Immunodeficiencies. Immunoglobulinopathies ; Immunopathology ; Infectious diseases ; Male ; Medical sciences ; Middle Aged ; Risk Assessment - methods ; Viral diseases ; Viral diseases of the lymphoid tissue and the blood. Aids</subject><ispartof>European journal of preventive cardiology, 2014-06, Vol.21 (6), p.739-748</ispartof><rights>The European Society of Cardiology 2014 2014</rights><rights>The European Society of Cardiology 2012 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav</rights><rights>2015 INIST-CNRS</rights><rights>The European Society of Cardiology 2012 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c445t-f0a50cc0f25a0d1453e09e0e07817b9d37e9f4edd5f447b4b5aa698dab9c6bca3</citedby><cites>FETCH-LOGICAL-c445t-f0a50cc0f25a0d1453e09e0e07817b9d37e9f4edd5f447b4b5aa698dab9c6bca3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,776,780,27903,27904</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=28677293$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/22718798$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Serrano-Villar, Sergio</creatorcontrib><creatorcontrib>Estrada, Vicente</creatorcontrib><creatorcontrib>Gómez-Garre, Dulcenombre</creatorcontrib><creatorcontrib>Ávila, Mario</creatorcontrib><creatorcontrib>Fuentes-Ferrer, Manuel</creatorcontrib><creatorcontrib>San, Román Jesús</creatorcontrib><creatorcontrib>Soriano, Vicente</creatorcontrib><creatorcontrib>Sánchez-Parra, Clara</creatorcontrib><creatorcontrib>Sainz, Talía</creatorcontrib><creatorcontrib>Fernández-Cruz, Arturo</creatorcontrib><title>Diagnosis of subclinical atherosclerosis in HIV-infected patients: higher accuracy of the D:A:D risk equation over Framingham and SCORE algorithms</title><title>European journal of preventive cardiology</title><addtitle>Eur J Cardiovasc Prev Rehabil</addtitle><description>Abstract
Aims
While the detection of subclinical atherosclerosis may provide an opportunity for the prevention of cardiovascular disease (CVD), which currently is a leading cause of death in HIV-infected subjects, its diagnosis is a clinical challenge. We aimed to compare the agreement and diagnostic performance of Framingham, SCORE and D:A:D equations for the recognition of subclinical atherosclerosis in HIV patients and to adjust the D:A:D equation using HIV and CVD variables.
Methods and results
Atherosclerosis was evaluated in 203 HIV-infected individuals by measuring the carotid intima-media thickness (IMT). The CVD risk was calculated using the Framingham, SCORE and D:A:D risk equations. Framingham, SCORE and D:A:D equations showed a low agreement with the IMT (Kappa: 0.219, 0.298, 0.244, respectively; p = 0.743) and a moderate predictive performance, (area under the curve [AUC] = 0.686, 0.665 and 0.716, respectively; p = 0.048), with the D:A:D equation being the most accurate. Atherosclerosis was demonstrated in a significant proportion of subjects with low predicted CVD risk by all three algorithms (16.3%, 17.2%, 17.2%, respectively; p = 0.743). In patients with an estimated low CVD risk atherosclerosis was associated with older age (p = 0.012) and low CD4 counts (p = 0.021). A model was developed to adjust the D:A:D equation; a significant increase in accuracy was obtained when CD4 counts and low-grade albuminuria were included (AUC = 0.772; p < 0.001).
Conclusion
The D:A:D equation overperforms Framingham and SCORE in HIV patients. However, all three equations underestimate the presence of subclinical atherosclerosis in this population. The accuracy of the D:A:D equation improves when CD4 counts and low-grade albuminuria are incorporated into the equation.</description><subject>Adult</subject><subject>Aged</subject><subject>Albuminuria - diagnosis</subject><subject>Algorithms</subject><subject>Atherosclerosis (general aspects, experimental research)</subject><subject>Atherosclerosis - diagnosis</subject><subject>Atherosclerosis - etiology</subject><subject>Biological and medical sciences</subject><subject>Blood and lymphatic vessels</subject><subject>Cardiology. Vascular system</subject><subject>Carotid Intima-Media Thickness</subject><subject>CD4 Lymphocyte Count</subject><subject>Cross-Sectional Studies</subject><subject>Female</subject><subject>Heart</subject><subject>HIV Infections - complications</subject><subject>Human viral diseases</subject><subject>Humans</subject><subject>Immunodeficiencies</subject><subject>Immunodeficiencies. Immunoglobulinopathies</subject><subject>Immunopathology</subject><subject>Infectious diseases</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Middle Aged</subject><subject>Risk Assessment - methods</subject><subject>Viral diseases</subject><subject>Viral diseases of the lymphoid tissue and the blood. Aids</subject><issn>2047-4873</issn><issn>2047-4881</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2014</creationdate><recordtype>article</recordtype><recordid>eNqFkV1L5DAUhsPiouJ675XkRhCkbpKmTTp3MuMXCIL7cVtO06QTbZMxaRf8G_uLzTCjC3uhuUjCyfO-ObwHoSNKzikV4jsjXHApcsp4waqSf0H761LGpaQ773eR76HDGB9JWiVhTMpdtMeYoFJUch_9XVjonI82Ym9wnBrVW2cV9BjGpQ4-qn69p2fr8M3t78w6o9WoW7yC0Wo3xhle2i6hGJSaAqiXtVHS4sXsYrbAwcYnrJ-nRHuH_Z8EXgUYrOuWMGBwLf4xv3-4xNB3PthxOcRv6KuBPurD7XmAfl1d_pzfZHf317fzi7tMcV6MmSFQEKWIYQWQlvIi16TSRBMhqWiqNhe6Mly3bWE4Fw1vCoCyki00lSobBfkBOt34roJ_nnQc68FGpfsenPZTrGlZSsYpITKhZIOqlEUM2tSrYAcILzUl9XoY9f_DSJLjrfvUDLp9F7xFn4CTLQAx5W0COGXjP06WQrAqT1y24SJ0un70U3AplY8-Ptvwflp93uYrNXysLA</recordid><startdate>20140601</startdate><enddate>20140601</enddate><creator>Serrano-Villar, Sergio</creator><creator>Estrada, Vicente</creator><creator>Gómez-Garre, Dulcenombre</creator><creator>Ávila, Mario</creator><creator>Fuentes-Ferrer, Manuel</creator><creator>San, Román Jesús</creator><creator>Soriano, Vicente</creator><creator>Sánchez-Parra, Clara</creator><creator>Sainz, Talía</creator><creator>Fernández-Cruz, Arturo</creator><general>Oxford University Press</general><general>SAGE Publications</general><general>Sage Publications</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20140601</creationdate><title>Diagnosis of subclinical atherosclerosis in HIV-infected patients: higher accuracy of the D:A:D risk equation over Framingham and SCORE algorithms</title><author>Serrano-Villar, Sergio ; Estrada, Vicente ; Gómez-Garre, Dulcenombre ; Ávila, Mario ; Fuentes-Ferrer, Manuel ; San, Román Jesús ; Soriano, Vicente ; Sánchez-Parra, Clara ; Sainz, Talía ; Fernández-Cruz, Arturo</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c445t-f0a50cc0f25a0d1453e09e0e07817b9d37e9f4edd5f447b4b5aa698dab9c6bca3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2014</creationdate><topic>Adult</topic><topic>Aged</topic><topic>Albuminuria - diagnosis</topic><topic>Algorithms</topic><topic>Atherosclerosis (general aspects, experimental research)</topic><topic>Atherosclerosis - diagnosis</topic><topic>Atherosclerosis - etiology</topic><topic>Biological and medical sciences</topic><topic>Blood and lymphatic vessels</topic><topic>Cardiology. Vascular system</topic><topic>Carotid Intima-Media Thickness</topic><topic>CD4 Lymphocyte Count</topic><topic>Cross-Sectional Studies</topic><topic>Female</topic><topic>Heart</topic><topic>HIV Infections - complications</topic><topic>Human viral diseases</topic><topic>Humans</topic><topic>Immunodeficiencies</topic><topic>Immunodeficiencies. Immunoglobulinopathies</topic><topic>Immunopathology</topic><topic>Infectious diseases</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Middle Aged</topic><topic>Risk Assessment - methods</topic><topic>Viral diseases</topic><topic>Viral diseases of the lymphoid tissue and the blood. Aids</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Serrano-Villar, Sergio</creatorcontrib><creatorcontrib>Estrada, Vicente</creatorcontrib><creatorcontrib>Gómez-Garre, Dulcenombre</creatorcontrib><creatorcontrib>Ávila, Mario</creatorcontrib><creatorcontrib>Fuentes-Ferrer, Manuel</creatorcontrib><creatorcontrib>San, Román Jesús</creatorcontrib><creatorcontrib>Soriano, Vicente</creatorcontrib><creatorcontrib>Sánchez-Parra, Clara</creatorcontrib><creatorcontrib>Sainz, Talía</creatorcontrib><creatorcontrib>Fernández-Cruz, Arturo</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>European journal of preventive cardiology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Serrano-Villar, Sergio</au><au>Estrada, Vicente</au><au>Gómez-Garre, Dulcenombre</au><au>Ávila, Mario</au><au>Fuentes-Ferrer, Manuel</au><au>San, Román Jesús</au><au>Soriano, Vicente</au><au>Sánchez-Parra, Clara</au><au>Sainz, Talía</au><au>Fernández-Cruz, Arturo</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Diagnosis of subclinical atherosclerosis in HIV-infected patients: higher accuracy of the D:A:D risk equation over Framingham and SCORE algorithms</atitle><jtitle>European journal of preventive cardiology</jtitle><addtitle>Eur J Cardiovasc Prev Rehabil</addtitle><date>2014-06-01</date><risdate>2014</risdate><volume>21</volume><issue>6</issue><spage>739</spage><epage>748</epage><pages>739-748</pages><issn>2047-4873</issn><eissn>2047-4881</eissn><abstract>Abstract
Aims
While the detection of subclinical atherosclerosis may provide an opportunity for the prevention of cardiovascular disease (CVD), which currently is a leading cause of death in HIV-infected subjects, its diagnosis is a clinical challenge. We aimed to compare the agreement and diagnostic performance of Framingham, SCORE and D:A:D equations for the recognition of subclinical atherosclerosis in HIV patients and to adjust the D:A:D equation using HIV and CVD variables.
Methods and results
Atherosclerosis was evaluated in 203 HIV-infected individuals by measuring the carotid intima-media thickness (IMT). The CVD risk was calculated using the Framingham, SCORE and D:A:D risk equations. Framingham, SCORE and D:A:D equations showed a low agreement with the IMT (Kappa: 0.219, 0.298, 0.244, respectively; p = 0.743) and a moderate predictive performance, (area under the curve [AUC] = 0.686, 0.665 and 0.716, respectively; p = 0.048), with the D:A:D equation being the most accurate. Atherosclerosis was demonstrated in a significant proportion of subjects with low predicted CVD risk by all three algorithms (16.3%, 17.2%, 17.2%, respectively; p = 0.743). In patients with an estimated low CVD risk atherosclerosis was associated with older age (p = 0.012) and low CD4 counts (p = 0.021). A model was developed to adjust the D:A:D equation; a significant increase in accuracy was obtained when CD4 counts and low-grade albuminuria were included (AUC = 0.772; p < 0.001).
Conclusion
The D:A:D equation overperforms Framingham and SCORE in HIV patients. However, all three equations underestimate the presence of subclinical atherosclerosis in this population. The accuracy of the D:A:D equation improves when CD4 counts and low-grade albuminuria are incorporated into the equation.</abstract><cop>London, England</cop><pub>Oxford University Press</pub><pmid>22718798</pmid><doi>10.1177/2047487312452964</doi><tpages>10</tpages><oa>free_for_read</oa></addata></record> |
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| source | Oxford Journals Online |
| subjects | Adult Aged Albuminuria - diagnosis Algorithms Atherosclerosis (general aspects, experimental research) Atherosclerosis - diagnosis Atherosclerosis - etiology Biological and medical sciences Blood and lymphatic vessels Cardiology. Vascular system Carotid Intima-Media Thickness CD4 Lymphocyte Count Cross-Sectional Studies Female Heart HIV Infections - complications Human viral diseases Humans Immunodeficiencies Immunodeficiencies. Immunoglobulinopathies Immunopathology Infectious diseases Male Medical sciences Middle Aged Risk Assessment - methods Viral diseases Viral diseases of the lymphoid tissue and the blood. Aids |
| title | Diagnosis of subclinical atherosclerosis in HIV-infected patients: higher accuracy of the D:A:D risk equation over Framingham and SCORE algorithms |
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