Limited Utility of Cardiovascular Risk Scores for People Living with HIV in Malawi

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Abstract HIV is associated with increased cardiovascular disease (CVD) risk. Despite the high prevalence of HIV in low income sub-Saharan Africa, there are few data on the assessment of CVD risk in the region. In this study, we aimed to compare the utility of existing CVD risk scores in a cohort of Malawian adults, and assess to what extent they correlate with established markers of endothelial damage: carotid intima-media thickness (IMT) and pulse wave velocity (PWV). WHO/ISH, SCORE, FRS, ASCVD, QRISK2 and D:A:D scores were calculated for 279 Malawian adults presenting with HIV and low CD4. Correlation of the calculated 10-year CVD risk score with IMT and PWV was assessed using Spearman’s rho. The median (IQR) age of patients was 37 (31 – 43) years and 122 (44%) were female. Median (IQR) blood pressure was 120/73mmHg (108/68 – 128/80) and 88 (32%) study participants had a new diagnosis of hypertension. The FRS and QRISK2 scores included the largest number of participants in this cohort (96% and 100% respectively). D:A:D, a risk score specific for people living with HIV, identified more patients in moderate and high-risk groups. Although all scores correlated well with physiological markers of endothelial damage, FRS and QRISK2 correlated most closely with both IMT [r 2 0.51, p<0.0001 and r 2 0.47, p<0.0001 respectively] and PWV [r 2 0.47, p<0.0001 and r 2 0.5, p<0.0001 respectively]. Larger cohort studies are required to adapt and validate risk prediction scores in this region, so that limited healthcare resources can be effectively targeted.

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