Background
Cardiovascular disease (CVD) risk in women living with HIV (WLWH) is shaped not only by traditional risk factors, but also by HIV-specific and women-specific factors. Primary prevention of CVD utilizes risk assessment models that show varying performance in WLWH. Predicting Risk of cardiovascular disease EVENTs (PREVENT) is a novel race/ethnicity-free sex-specific calculator that estimates 10y and 30y atherosclerotic cardiovascular disease (ASCVD), heart failure (HF), and composite CVD risks based on cardiovascular-metabolic-kidney disease risk factors and optional incorporation of social deprivation index (SDI, US only). Here, we describe PREVENT-based CVD risk in women living with and without HIV.
Methods
British Columbia CARMA-CHIWOS Collaboration (BCC3) is a prospective cohort study enrolling women ≥16y living with and without HIV in British Columbia, Canada since 2020. Participants aged 30-79y with no history of coronary heart disease, stroke, or HF, were included. The base PREVENT model was used (without SDI) to calculate 10y and 30y risks of ASCVD, HF, and CVD, with the 30y risk offering a long-term preventative estimate among women aged 30-59y only. Data were self-reported, or based on the study visit clinical blood tests. Groups were compared by Chi-Squared or Mann-Whitney tests.
Results
A total of 164 WLWH and 187 women without HIV were included (25 WLWH and 33 controls excluded due to prior history). WLWH and controls had similar socio-demographic characteristics and shared many risk factors for CVD: age (median [IQR] 49 [43-57] vs 50 [41-58] years, p=0.50), current smoking (40% vs 36%) diabetes (both 8%), antihypertensive medication use (16% vs 12%), current substance use (21% vs 25%), BMI, blood pressure, and total cholesterol (all p>0.05). WLWH were more likely to report a history of hepatitis C (38% vs 15%) and use of lipid-lowering medication (16% vs 5%), but had lower HDL and eGFR compared to women without HIV (all p<0.01). The PREVENT base model revealed no difference in 10y risk of ASCVD, HF, or CVD between the groups, but a higher 30y risk for ASCVD and CVD in WLWH compared to women without HIV (Table 1).
Conclusions
Despite similar 10y ASCVD, HF, and CVD risk estimates, WLWH showed higher 30y risk of CVD outcomes. This could reflect long-term implications of HDL/eGFR differences between the groups, or the impact of factors not captured by PREVENT, including higher exposure to adverse life events, chronic immune activation, and non-HIV chronic/latent viruses.
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