Cardiovascular (CV) disease (CVD) and associated risk factors have been linked with neurocognitive impairment (NCI) in cross-sectional studies of persons living with HIV (PLHIV), although the specific CV risk factors that correlate with NCI have varied. We examined the utility of two commonly used 10-year CV risk scores–the Atherosclerotic CVD (ASCVD) and Framingham Heart Study Global CVD risk score (FRS), which combine multiple CV risk factors–to predict longitudinal cognitive function in an observational cohort of older PLHIV.
Participants from the ongoing AIDS Clinical Trials Group A5322 study who underwent neurocognitive testing (Trailmaking A and B, Hopkins Verbal Learning Test-Revised, Digit Symbol) at entry were eligible. Raw scores are standardized using demographics-adjusted norms and combined into a summary z-score (NPZ-4). Participants undergo repeat neurocognitive testing every 48 weeks. The 10-year ASCVD risk score and FRS were calculated at entry. We first assessed how well the baseline ASCVD risk score and FRS predicted NPZ-4 at Year 4 in unadjusted linear regression models. We then performed stepwise linear regression (Table) to determine the covariate-adjusted association between baseline 10-year CV risk and NPZ-4 at Year 4.
Of 988 participants, mean age was 52 years, 20% were women, and 90% had an undetectable viral load. Mean ASCVD risk score and FRS were 6.8% and 13.1%, respectively. Both risk scores were lower in women than men (ASCVD 4.1% vs. 7.5%, p<0.001; FRS 8.1% vs. 14.3%, p<0.001). For every 1% higher baseline ASCVD risk, NPZ-4 at Year 4 was lower by 1.4 SD (p=0.003). Baseline ASCVD risk predicted NPZ-4 at Year 4 overall and in both women and men (Table). In adjusted models, for every 1% higher baseline ASCVD risk, NPZ-4 at Year 4 was 1.1 SD lower, though this did not reach statistical significance (p=0.085). Baseline ASCVD risk significantly predicted NPZ-4 at Year 4 for women (-3.1 SD per 1% higher risk, p=0.010) but not for men (-0.4 SD per 1% higher risk, p=0.55), even after adjustment for NPZ-4 at entry. The associations between baseline FRS and NPZ-4 were comparable, although higher ASCVD risk had a greater effect on NPZ-4 than higher FRS (Table).
Higher baseline 10-year CV risk predicted worse cognitive function at Year 4 in PLHIV, though this association was attenuated in men after adjusting for covariates. A higher CV risk score may help to identify PLHIV who are at risk for worse cognitive function over time.