Use of Coronary Artery Calcium Scoring to Improve Cardiovascular Risk Stratification and Guide Decisions to Start Statin Therapy in People Living With HIV
Use of Coronary Artery Calcium Scoring to Improve Cardiovascular Risk Stratification and Guide Decisions to Start Statin Therapy in People Living With HIV
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DOI：
10.1097/qai.0000000000002400
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发表时间：
2020-09-01
影响因子：
3.6
通讯作者：
Boffito, Marta
中科院分区：
文献类型：
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作者：
Pereira, Branca;Mazzitelli, Maria;Boffito, Marta
背景资料：心血管疾病（CVD）风险评估仍然是指导决定在艾滋病毒感染者（PLWH）中启动初级预防干预措施的关键步骤。设定：我们研究了冠状动脉钙化（CAC）评分是否可以更准确地选择可能受益于他汀类药物治疗的患者，与目前的风险评估工具相比。方法：对2009年至2019年进行CAC评分的50岁以上PLWH进行横断面分析。在CAC评分和他汀类药物资格确定时，计算每名参与者的FractionalRisk评分（FRS）、QRISK2和D：A：D评分，这些评分是基于PLWH中预防CVD的现行欧洲指南确定的。结果：共纳入739例患者（平均年龄56 ± 5岁，92.8%为男性，84%为白色）。在417例（56.4%）基于FRS ≥ 10%的他汀类药物治疗候选者中，174例（23.5%）未检测到钙化（CAC = 0）。相反，145例（19.6%）可检测到钙化（CAC > 0）的患者被确定为低风险（FRS < 10%）。与FRS相比，CAC评分将43.1%的患者的CVD风险重新分类，145例（19.6%）患者为可从他汀类药物治疗中获益的高风险组，174例（23.5%）候选他汀类药物患者为低风险组。QRISK2和D：A：D评分的表现与FRS相似，分别低估了21.1%和24.9%的显著冠状动脉钙化的存在，高估了16.9%和18.8%的CAC = 0的患者的风险。结论：建立一个决策模型的基础上结合传统的风险工具和CAC评分改善风险评估和选择PLWH谁将受益于他汀类药物治疗。
Background: Cardiovascular disease (CVD) risk assessment remains a critical step in guiding decisions to initiate primary prevention interventions in people living with HIV (PLWH). Setting: We investigated whether coronary artery calcium (CAC) scoring allowed a more accurate selection of patients who may benefit from statin therapy, compared with current risk assessment tools alone. Methods: Cross-sectional analysis of PLWH over 50 years old who underwent CAC scoring between 2009 and 2019. Framingham Risk score (FRS), QRISK2 and D:A:D scores were calculated for each participant at the time of CAC scoring and statin eligibility determined based on current European guidelines on the prevention of CVD in PLWH. Results: A total of 739 patients were included (mean age 56 +/- 5, 92.8% male, 84% white). Among 417 (56.4%) candidates for statin therapy based on FRS >= 10%, 174 (23.5%) had no detectable calcification (CAC = 0). Conversely, 145 (19.6%) patients with detectable calcification (CAC > 0) were identified as low-risk (FRS < 10%). When compared with FRS, CAC scoring reclassified CVD risk in 43.1% of patients, 145 (19.6%) to a higher risk group that could benefit from statin therapy and 174 (23.5%) statin candidates to a lower risk group. QRISK2 and D:A:D scores performed similarly to FRS, underestimating the presence of significant coronary calcification in 21.1% and 24.9% respectively and overestimating risk in 16.9% and 18.8% patients with CAC = 0. Conclusions: Establishing a decision-model based on the combination of conventional risk tools and CAC scoring improves risk assessment and the selection of PLWH who would benefit from statin therapy.