Risk Assessment in a Global CVD Prevention Cohort of People With HIV by PCE, PREVENT, and SCORE2

Abstract

Background. REPRIEVE findings catalyzed changes to multiple guidelines directing statin therapy prescribing for people with HIV (PWH). US guidelines use the pooled cohort equation (PCE)-derived 10-year atherosclerotic cardiovascular disease (ASCVD) risk score but may in the future incorporate the new Predicting Risk of CVD EVENTs (PREVENT) score. Meanwhile, European guidelines use Systematic Coronary Risk Evaluation 2 (SCORE2). Methods Leveraging Randomized Trial to Prevent Vascular Events in HIV (REPRIEVE), we compared effects of applying PCE versus either PREVENT according to US guidelines or SCORE2 according to European guidelines among a global primary CVD prevention cohort of PWH. Results. Analysis cohort included 7757 participants with data for PREVENT and SCORE2 calculation. Ten-year ASCVD risk estimates (median [Q1, Q3]) were highest with PCE (4.4% [2.1%, 7.1%]) versus SCORE2 (3.3% [2.0%, 4.9%]) and PREVENT (2.2% [1.3%, 3.3%]). PREVENT- (vs PCE-) based scoring reclassified 38% of participants from a higher to a lower risk group (≥5% to <5%), while SCORE2-based scoring analogously shifted 27% of those age ≥50 years. Among placebo-assigned participants, median observed incidence of hard major adverse cardiovascular events (MACEs)/1000 person-years (PY) was higher than that predicted by PREVENT, except for those with ultralow predicted risk. The estimated cumulative incidence of primary MACE was higher and 5-year number needed to treat (NNT5) lower for most risk groups using PREVENT versus PCE. The NNT5 for the PREVENT-defined risk group of 2.5–5.0% was close to the NNT5 for the PCE-defined risk group of ≥5% (NNT5[95% CI]: 53 [31, 178] vs 47 [30, 109], respectively). Conclusions Statin-prescribing guidelines for PWH based on REPRIEVE should account for differences in 10-year ASCVD risk estimates when scores other than PCE are used.