Level of agreement between frequently used cardiovascular risk calculators in people living with HIV

the Pharmacokinetic and Clinical Observations in People over Fifty (POPPY) study

Research output: Contribution to journalArticlepeer-review

7 Citations (Scopus)

Abstract

Objectives: The aim of the study was to describe agreement between the QRISK2, Framingham and Data Collection on Adverse Events of Anti-HIV Drugs (D:A:D) cardiovascular disease (CVD) risk calculators in a large UK study of people living with HIV (PLWH). Methods: PLWH enrolled in the Pharmacokinetic and Clinical Observations in People over Fifty (POPPY) study without a prior CVD event were included in this study. QRISK2, Framingham CVD and the full and reduced D:A:D CVD scores were calculated; participants were stratified into ‘low’ (< 10%), ‘intermediate’ (10–20%) and ‘high’ (> 20%) categories for each. Agreement between scores was assessed using weighted kappas and Bland–Altman plots. Results: The 730 included participants were predominantly male (636; 87.1%) and of white ethnicity (645; 88.5%), with a median age of 53 [interquartile range (IQR) 49–59] years. The median calculated 10-year CVD risk was 11.9% (IQR 6.8–18.4%), 8.9% (IQR 4.6–15.0%), 8.5% (IQR 4.8–14.6%) and 6.9% (IQR 4.1–11.1%) when using the Framingham, QRISK2, and full and reduced D:A:D scores, respectively. Agreement between the different scores was generally moderate, with the highest level of agreement being between the Framingham and QRISK2 scores (weighted kappa = 0.65) but with most other kappa coefficients in the 0.50–0.60 range. Conclusions: Estimates of predicted 10-year CVD risk obtained with commonly used CVD risk prediction tools demonstrate, in general, only moderate agreement among PLWH in the UK. While further validation with clinical endpoints is required, our findings suggest that care should be taken when interpreting any score alone.

Original languageEnglish
Pages (from-to)347-352
Number of pages6
JournalHIV Medicine
Volume20
Issue number5
DOIs
Publication statusPublished - May 2019

Bibliographical note

Funding Information:
We thank all the participants in the study. We acknowledge the use of the NIHR/Wellcome Trust Clinical Research Facility at King’s College Hospital. The research is supported by the National Institute for Health Research (NIHR) Biomedical Research Centre based at Imperial College Healthcare NHS Trust and Imperial College London and by an NIHR Senior Investigator Award to CAS. The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR or the Department of Health. All the POPPY clinical sites in the UK are grateful for NIHR Clinical Research Network (CRN) support.

Funding Information:
We thank all the participants in the study. We acknowledge the use of the NIHR/Wellcome Trust Clinical Research Facility at King's College Hospital. The research is supported by the National Institute for Health Research (NIHR) Biomedical Research Centre based at Imperial College Healthcare NHS Trust and Imperial College London and by an NIHR Senior Investigator Award to CAS. The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR or the Department of Health. All the POPPY clinical sites in the UK are grateful for NIHR Clinical Research Network (CRN) support. Funding: This work is supported by investigator-initiated grants from Bristol-Myers Squibb, Gilead Sciences, Janssen-Cilag, Merck Sharp and Dohme, and ViiV Healthcare. Conflicts of interest: CAS has received funding from Gilead Sciences, ViiV Healthcare and Janssen-Cilag for membership of data safety and monitoring boards, advisory boards and speaker panels and for the preparation of educational materials. FP has received research grants from Gilead Sciences and ViiV Healthcare, and funding from Gilead Sciences, ViiV Healthcare, Merck Sharp and Dohme and Janssen-Cilag for membership of advisory boards and speaker panels and/or for the preparation of educational materials. MB has received speaking fees from Gilead Sciences, Merck Sharp and Dohme and Janssen-Cilag, advisory fees from ViiV Healthcare, Gilead Sciences and Merck Sharp and Dohme, honoraria from Gilead Sciences for membership of a speaker bureau and a travel grant from Gilead Sciences, and has been the principal investigator in clinical trials sponsored by Gilead Sciences, ViiV Healthcare, Mylan, Janssen-Cilag and Bristol-Myers Squibb. JA has received grants, personal fees and nonfinancial support from Gilead Sciences, Merck Sharp and Dohme, Janssen-Cilag and Bristol-Myers Squibb, and nonfinancial support from ViiV Healthcare. PWM has received funding for membership of advisory boards and speaker panels, and preparation of educational materials, and/or research grants to his institution from Gilead Sciences, ViiV Healthcare, Bristol-Myers Squibb, Merck Sharp and Dohme, Abbvie and Janssen-Cilag. AW has received honoraria or research grants from ViiV Healthcare, Gilead Sciences, Bristol-Myers Squibb, Merck Sharp and Dohme and Janssen-Cilag. EB, MS, IW, JV, MJ and DB have nothing to declare.

Funding Information:
Conflicts of interest: CAS has received funding from Gilead Sciences, ViiV Healthcare and Janssen-Cilag for membership of data safety and monitoring boards, advisory boards and speaker panels and for the preparation of educational materials. FP has received research grants from Gilead Sciences and ViiV Healthcare, and funding from Gilead Sciences, ViiV Healthcare, Merck Sharp and Dohme and Janssen-Cilag for membership of advisory boards and speaker panels and/or for the preparation of educational materials. MB has received speaking fees from Gilead Sciences, Merck Sharp and Dohme and Jans-sen-Cilag, advisory fees from ViiV Healthcare, Gilead Sciences and Merck Sharp and Dohme, honoraria from Gilead Sciences for membership of a speaker bureau and a travel grant from Gilead Sciences, and has been the principal investigator in clinical trials sponsored by Gilead Sciences, ViiV Healthcare, Mylan, Janssen-Cilag and Bristol-Myers Squibb. JA has received grants, personal fees and nonfinancial support from Gilead Sciences, Merck Sharp and Dohme, Janssen-Cilag and Bristol-Myers Squibb, and nonfinancial support from ViiV Healthcare. PWM has received funding for membership of advisory boards and speaker panels, and preparation of educational materials, and/or research grants to his institution from Gilead Sciences, ViiV Healthcare, Bristol-Myers Squibb, Merck Sharp and Dohme, Abbvie and Janssen-Cilag. AW has received honoraria or research grants from ViiV Healthcare, Gilead Sciences, Bristol-Myers Squibb, Merck Sharp and Dohme and Janssen-Cilag. EB, MS, IW, JV, MJ and DB have nothing to declare.

Funding Information:
Funding: This work is supported by investigator-initiated grants from Bristol-Myers Squibb, Gilead Sciences, Janssen-Cilag, Merck Sharp and Dohme, and ViiV Healthcare.

Publisher Copyright:
© 2019 The Authors. HIV Medicine published by John Wiley & Sons Ltd on behalf of British HIV Association

Keywords

  • Data Collection on Adverse Events of Anti-HIV Drugs (D:A:D) risk score
  • Framingham
  • HIV
  • QRISK2
  • agreement
  • cardiovascular risk prediction

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