Dr Jorge Plutzky Explains How Traditional CV Risk Prediction Models Fall Short for Patients With HIV

Traditional cardiovascular risk prediction models may not apply accurately to patients with HIV who may develop the cardiovascular disease younger than usual, said Jorge Plutzky, MD, director of the Vascular Disease Prevention Program and director of Preventive Cardiology at Brigham and Women’s Hospital and associate professor of medicine at Harvard Medical School.

Transcript

Why is there a need for different cardiovascular disease prediction models for people living with HIV? How do current prediction models fall short?

The occurrence of cardiovascular disease in patients with HIV has raised questions about prediction models that we typically use may not be relevant. These patients could be younger, they have other issues going on, they’re on other medicines. There may be this issue with inflammation as a driver of it. And so, it has prompted the question of stepping back and looking to what extent do our traditional risk prediction models apply in patients with HIV, because they just may be different.

They may also require consideration of the same kinds of drivers of disease but being present in people who are younger. And so rather than making an assumption that this couldn't be a problem, now, because someone is too young, embracing the fact that one so has to consider whether or not that's an issue, given what we see epidemiologically.

It's also interesting that that's those same sorts of issues apply in other diseases. So, we're involved with some very exciting, important work looking at cardiovascular risk in rheumatologic diseases. And I have colleagues at the Brigham who are really focused on that. And it goes hand in hand with the idea that maybe inflammation is a contributor, and also the fact that we now have much more potent anti-inflammatory drugs that are being used in rheumatology, that may uncouple the usual patterns that we see with changes in lipids in terms of cardiovascular disease, as their inflammation gets controlled. Lipid and cholesterol parameters are influenced by inflammation and acute phase responses that can occur with inflammatory diseases, the therapies can shift that.

And so, the numbers have been demonstrated as having patterns that are surprising, and maybe not what are predicted in terms of outcomes and is forcing this question of revisiting, how we predict cardiovascular risk in those kinds of settings like HIV and rheumatologic disorders?