The potential impact of new national guidance on primary prevention of cardiovascular disease in people living with HIV.

Abstract:

INTRODUCTION:Cardiovascular disease (CVD) is the leading cause of death in England and Wales. As people living with HIV (PLWH) age, proactive management of CVD risk factors is crucial. The long-awaited draft guidelines for CVD from the National Institute of Clinical Excellence (NICE) propose lipid modification (with statins) and lifestyle modification for 40-74 year olds with >10% (previously >20%) 10-year risk of CVD using QRISK2. We currently use Framingham so compared 3 CVD risk calculators in our cohort and analyzed the impact of a change in CVD threshold on the proportion of our patients who would need intervention. MATERIALS AND METHODS:Framingham, QRISK2 and JBS3 cardiovascular risk calculators were compared in a group of randomly selected patients. Then, to analyze the impact of a change in primary prevention threshold on our cohort, we interrogated a prospectively collected database to identify all individuals who had a documented Framingham risk assessment and applied the current/proposed thresholds accordingly. We performed the same analysis for the three calculator subgroup (recalculating Framingham risk). Finally we surveyed HIV services in England & Wales regarding their choice of calculator. RESULTS:We compared the 3 CVD risk calculators in 100 patients, see Table 1. CONCLUSIONS:Reducing the threshold for cardiovascular preventative measures to 10% vastly increases the number of patients requiring primary intervention, from two- to fourfold depending on risk calculator used. This may have significant implications, including cost, drug-drug interactions and patient experience, that HIV physicians and general practitioners will need to address, ideally in a coordinated and patient-focused manner.

journal_name

J Int AIDS Soc

authors

Ahmed N,Bradley S,Pearson P,Edwards S,Waters L

doi

10.7448/IAS.17.4.19713

subject

Has Abstract

pub_date

2014-11-02 00:00:00

pages

19713

issue

4 Suppl 3

issn

1758-2652

pii

19713

journal_volume

17

pub_type

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