Cardiovascular Risk Assessment Varies Widely by Calculator and Race/Ethnicity in a Majority Latinx Cohort Living with HIV

  • Yuanyuan Liang
  • Norma S. Ketchum
  • Barbara J. Turner
  • John Flores
  • Delia Bullock
  • Roberto Villarreal
  • Polly H. Noël
  • Michael T. Yin
  • Barbara S. TaylorEmail author
Original Paper


Comparison of cardiovascular disease (CVD) risk calculators in Latinx majority populations living with HIV can assist clinicians in selecting a calculator and interpreting results. 10-year CVD risks were estimated for 652 patients seen ≥ 2 times over 12 months in a public clinic using three risk calculators: Atherosclerotic CVD risk Calculator (ASCVD), Framingham Risk Calculator (FRC), and Data Collection on Adverse Effects of Anti-HIV Drugs Study (D:A:D) Calculator. Median estimated 10-year CVD risk in this population was highest using FRC (11%), followed by D:A:D (10%), and lowest with ASCVD (5%; p < 0.001). However, D:A:D classified 44.3% in a high/very high risk category compared to FRC (20.7%) and ASCVD (33.4%) (all p < 0.001). ASCVD risk estimates differed significantly by race/ethnicity (p < 0.001). Risk varied widely across three risk calculators and by race/ethnicity, and providers should be aware of these differences when choosing a calculator for use in majority minority populations.


HIV Cardiovascular risk Cardiovascular risk calculation Race Ethnicity Hispanic 



This study was funded by an American Heart Association grant to BT. The authors wish to gratefully acknowledge the staff and providers at the FFACTS clinic and the research administration of the University Health System for their support of this investigation.


This study was funded by the American Heart Association (Grant No. 14CRP20150023).

Compliance with Ethical Standards

Conflict of interest

The authors declare that they have no conflict of interest.


  1. 1.
    Samji H, Cescon A, Hogg RS, Modur SP, Althoff KN, Buchacz K, Burchell AN, Cohen M, Gebo KA, Gill MJ, Justice A, Kirk G, Klein MB, Korthuis PT, Martin J, Napravnik S, Rourke SB, Sterling TR, Silverberg MJ, Deeks S, Jacobson LP, Bosch RJ, Kitahata MM, Goedert JJ, Moore R, Gange SJ. Closing the gap: increases in life expectancy among treated HIV-positive individuals in the United States and Canada. PLoS ONE. 2013;8(12):e81355.CrossRefGoogle Scholar
  2. 2.
    May MT, Gompels M, Delpech V, Porter K, Orkin C, Kegg S, Hay P, Johnson M, Palfreeman A, Gilson R, Chadwick D, Martin F, Hill T, Walsh J, Post F, Fisher M, Ainsworth J, Jose S, Leen C, Nelson M, Anderson J, Sabin C, Study UKCHC. Impact on life expectancy of HIV-1 positive individuals of CD4 + cell count and viral load response to antiretroviral therapy. AIDS. 2014;28(8):1193–202.CrossRefGoogle Scholar
  3. 3.
    Palella FJ Jr, Baker RK, Moorman AC, Chmiel JS, Wood KC, Brooks JT, Holmberg SD, Investigators HIVOS. Mortality in the highly active antiretroviral therapy era: changing causes of death and disease in the HIV outpatient study. J Acquir Immune Defic Syndr. 2006;43(1):27–34.CrossRefGoogle Scholar
  4. 4.
    Lewden C, May T, Rosenthal E, Burty C, Bonnet F, Costagliola D, Jougla E, Semaille C, Morlat P, Salmon D, Cacoub P, Chene G, Group AEMS, Mortavic. Changes in causes of death among adults infected by HIV between 2000 and 2005: the “Mortalite 2000 and 2005” surveys (ANRS EN19 and Mortavic). J Acquir Immune Defic Syndr. 2008;48(5):590–8.CrossRefGoogle Scholar
  5. 5.
    Antiretroviral Therapy Cohort C. Causes of death in HIV-1-infected patients treated with antiretroviral therapy, 1996–2006: collaborative analysis of 13 HIV cohort studies. Clin Infect Dis. 2010;50(10):1387–96.CrossRefGoogle Scholar
  6. 6.
    Triant VA. HIV infection and coronary heart disease: an intersection of epidemics. J Infect Dis. 2012;205(Suppl 3):S355–61.CrossRefGoogle Scholar
  7. 7.
    Obel N, Thomsen HF, Kronborg G, Larsen CS, Hildebrandt PR, Sorensen HT, Gerstoft J. Ischemic heart disease in HIV-infected and HIV-uninfected individuals: a population-based cohort study. Clin Infect Dis. 2007;44(12):1625–31.CrossRefGoogle Scholar
  8. 8.
    Feinstein MJ, Bahiru E, Achenbach C, Longenecker CT, Hsue P, So-Armah K, Freiberg MS, Lloyd-Jones DM. Patterns of cardiovascular mortality for HIV-infected adults in the United States: 1999 to 2013. Am J Cardiol. 2016;117(2):214–20.CrossRefGoogle Scholar
  9. 9.
    Taylor BS, Liang Y, Garduno LS, Walter EA, Gerardi MB, Anstead GM, Bullock D, Turner BJ. High risk of obesity and weight gain for HIV-infected uninsured minorities. J Acquir Immune Defic Syndr. 2014;65(2):e33–40.CrossRefGoogle Scholar
  10. 10.
    Allan GM, Nouri F, Korownyk C, Kolber MR, Vandermeer B, McCormack J. Agreement among cardiovascular disease risk calculators. Circulation. 2013;127(19):1948–56.CrossRefGoogle Scholar
  11. 11.
    Regan S, Meigs JB, Massaro J, Triant V, editors. Evaluation of the ACC/AHA CVD risk prediction algorithm among HIV-infected patients. In: Conference on retroviruses and opportunistic infections (CROI); 2015 February 23–26, 2015; Seattle, Washington.Google Scholar
  12. 12.
    Thompson-Paul AM, Lichtenstein KA, Armon C, Palella FJ Jr, Skarbinski J, Chmiel JS, Hart R, Wei SC, Loustalot F, Brooks JT, Buchacz K. Cardiovascular disease risk prediction in the HIV Outpatient Study. Clin Infect Dis. 2016;63(11):1508–16.CrossRefGoogle Scholar
  13. 13.
    D’Agostino RB Sr. Cardiovascular risk estimation in 2012: lessons learned and applicability to the HIV population. J Infect Dis. 2012;205(Suppl 3):S362–7.CrossRefGoogle Scholar
  14. 14.
    Friis-Møller N, Worm SW. Can the risk of cardiovascular disease in HIV-infected patients be estimated from conventional risk prediction tools? Clin Infect Dis. 2007;45(8):1082–4.CrossRefGoogle Scholar
  15. 15.
    Friis-Moller N, Thiebaut R, Reiss P, Weber R, Monforte AD, De Wit S, El-Sadr W, Fontas E, Worm S, Kirk O, Phillips A, Sabin CA, Lundgren JD, Law MG. Predicting the risk of cardiovascular disease in HIV-infected patients: the data collection on adverse effects of anti-HIV drugs study. Eur J Cardiovasc Prev Rehabil. 2010;17(5):491–501.CrossRefGoogle Scholar
  16. 16.
    Goff DC Jr, Lloyd-Jones DM, Bennett G, Coady S, D’Agostino RB, Gibbons R, Greenland P, Lackland DT, Levy D, O’Donnell CJ, Robinson JG, Schwartz JS, Shero ST, Smith SC Jr, Sorlie P, Stone NJ, Wilson PW, Jordan HS, Nevo L, Wnek J, Anderson JL, Halperin JL, Albert NM, Bozkurt B, Brindis RG, Curtis LH, DeMets D, Hochman JS, Kovacs RJ, Ohman EM, Pressler SJ, Sellke FW, Shen WK, Tomaselli GF. 2013 ACC/AHA guideline on the assessment of cardiovascular risk: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation. 2014;129(25 Suppl 2):S49–73.CrossRefGoogle Scholar
  17. 17.
    Noumegni SR, Bigna JJ, Epse Nkegoum VJ, Nansseu JR, Assah FK, Jingi AM, Guewo-Fokeng M, Leumi S, Katte JC, Dehayem MY, Kuate LM, Kengne AP, Sobngwi E. Relationship between estimated cardiovascular disease risk and insulin resistance in a black African population living with HIV: a cross-sectional study from Cameroon. BMJ Open. 2017;7(8):e016835.CrossRefGoogle Scholar
  18. 18.
    Cortes YI, Reame N, Zeana C, Jia H, Ferris DC, Shane E, Yin MT. Cardiovascular risk in HIV-infected and uninfected postmenopausal minority women: use of the Framingham risk score. J Womens Health. 2017;26(3):241–8.CrossRefGoogle Scholar
  19. 19.
    Daviglus ML, Talavera GA, Aviles-Santa ML, Allison M, Cai J, Criqui MH, Gellman M, Giachello AL, Gouskova N, Kaplan RC, LaVange L, Penedo F, Perreira K, Pirzada A, Schneiderman N, Wassertheil-Smoller S, Sorlie PD, Stamler J. Prevalence of major cardiovascular risk factors and cardiovascular diseases among Hispanic/Latino individuals of diverse backgrounds in the United States. JAMA. 2012;308(17):1775–84.CrossRefGoogle Scholar
  20. 20.
    Stark Casagrande S, Fradkin JE, Saydah SH, Rust KF, Cowie CC. The prevalence of meeting A1C, blood pressure, and LDL goals among people with diabetes, 1988-2010. Diabetes Care. 2013;36(8):2271–9.CrossRefGoogle Scholar
  21. 21.
    Rodriguez CJ, Allison M, Daviglus ML, Isasi CR, Keller C, Leira EC, Palaniappan L, Pina IL, Ramirez SM, Rodriguez B, Sims M, Stroke N, Status of cardiovascular disease and stroke in Hispanics/Latinos in the United States: a science advisory from the American Heart Association. Status of cardiovascular disease and stroke in Hispanics/Latinos in the United States: a science advisory from the American Heart Association. Circulation. 2014;130(7):593–625.CrossRefGoogle Scholar
  22. 22.
    U.S. Center for Disease Control and Prevention. HIV Surveillance Report, 2015. In:, editor. Atlanta, Georgia. November, 2016. Accessed 25 Aug 2017.
  23. 23.
    Reif SS, Whetten K, Wilson ER, McAllaster C, Pence BW, Legrand S, Gong W. HIV/AIDS in the Southern USA: a disproportionate epidemic. AIDS Care. 2014;26(3):351–9.CrossRefGoogle Scholar
  24. 24.
    Rosenberg ES, Grey JA, Sanchez TH, Sullivan PS. Rates of prevalent HIV infection, prevalent diagnoses, and new diagnoses among men who have sex with men in US states, metropolitan statistical areas, and counties, 2012–2013. JMIR Public Health Surveill. 2016;2(1):e22.CrossRefGoogle Scholar
  25. 25.
    Centers for Disease Control and Prevention. HIV Surveillance Report, 2016. GA: Atlanta; 2017.Google Scholar
  26. 26.
    D’Agostino RB Sr, Vasan RS, Pencina MJ, Wolf PA, Cobain M, Massaro JM, Kannel WB. General cardiovascular risk profile for use in primary care: the Framingham Heart Study. Circulation. 2008;117(6):743–53.CrossRefGoogle Scholar
  27. 27.
    Panel on Antiretroviral Guidelines for Adults and Adolescents. Guidelines for the use of antiretroviral agents in HIV-1-infected adults and adolescents. Section: Management of the Treatment Experienced Patient, Virologic Failure.: Department of Health and Human Services.; 2015. Accessed 29 June 2016.
  28. 28.
    Krikke M, Hoogeveen RC, Hoepelman AI, Visseren FL, Arends JE. Cardiovascular risk prediction in HIV-infected patients: comparing the Framingham, atherosclerotic cardiovascular disease risk score (ASCVD), Systematic Coronary Risk Evaluation for the Netherlands (SCORE-NL) and Data Collection on Adverse Events of Anti-HIV Drugs (D:A:D) risk prediction models. HIV Med. 2016;17(4):289–97.CrossRefGoogle Scholar
  29. 29.
    Mosepele M, Hemphill LC, Palai T, Nkele I, Bennett K, Lockman S, Triant VA. Cardiovascular disease risk prediction by the American College of Cardiology (ACC)/American Heart Association (AHA) Atherosclerotic Cardiovascular Disease (ASCVD) risk score among HIV-infected patients in sub-Saharan Africa. PLoS ONE. 2017;12(2):e0172897.CrossRefGoogle Scholar
  30. 30.
    Begovac J, Dragovic G, Viskovic K, Kusic J, Perovic Mihanovic M, Lukas D, Jevtovic D. Comparison of four international cardiovascular disease prediction models and the prevalence of eligibility for lipid lowering therapy in HIV infected patients on antiretroviral therapy. Croat Med J. 2015;56(1):14–23.CrossRefGoogle Scholar
  31. 31.
    Friis-Moller N, Ryom L, Smith C, Weber R, Reiss P, Dabis F, De Wit S, Monforte AD, Kirk O, Fontas E, Sabin C, Phillips A, Lundgren J, Law M, group DADs. An updated prediction model of the global risk of cardiovascular disease in HIV-positive persons: the Data-collection on Adverse Effects of Anti-HIV Drugs (D:A:D) study. Eur J Prev Cardiol. 2016;23(2):214–23.CrossRefGoogle Scholar
  32. 32.
    Clement ME, Park L, Navar-Boggan AM, Okeke NL, Pencina M, Douglas P, Naggie P, editors. HIV-infected veterans and the new ACC/AHA Cholesterol Guidelines: Got statins? In: Conference on Retroviruses and Opportunistic Infections (CROI); 2015 February 23–26, 2015; Seattle, Washington.Google Scholar
  33. 33.
    Cortes-Bergoderi M, Goel K, Murad MH, Allison T, Somers VK, Erwin PJ, Sochor O, Lopez-Jimenez F. Cardiovascular mortality in Hispanics compared to non-Hispanic whites: a systematic review and meta-analysis of the Hispanic paradox. Eur J Intern Med. 2013;24(8):791–9.CrossRefGoogle Scholar
  34. 34.
    Tam J, Warner KE, Gillespie BW, Gillespie JA. Impact of changing U.S. demographics on the decline in smoking prevalence, 1980–2010. Nicotine Tob Res. 2014;16(6):864–6.CrossRefGoogle Scholar
  35. 35.
    Rodriguez F, Lin S, Maron DJ, Knowles JW, Virani SS, Heidenreich PA. Use of high-intensity statins for patients with atherosclerotic cardiovascular disease in the Veterans Affairs Health System: practice impact of the new cholesterol guidelines. Am Heart J. 2016;182:97–102.CrossRefGoogle Scholar
  36. 36.
    Zanni MV, Fitch KV, Feldpausch M, Han A, Lee H, Lu MT, Abbara S, Ribaudo H, Douglas PS, Hoffmann U, Lo J, Grinspoon SK. 2013 American College of Cardiology/American Heart Association and 2004 Adult Treatment Panel III cholesterol guidelines applied to HIV-infected patients with/without subclinical high-risk coronary plaque. AIDS. 2014;28(14):2061–70.CrossRefGoogle Scholar
  37. 37.
    Ramirez AG, Munoz E, Holden AE, Adeigbe RT, Suarez L. Incidence of hepatocellular carcinoma in Texas Latinos, 1995–2010: an update. PLoS ONE. 2014;9(6):e99365.CrossRefGoogle Scholar
  38. 38.
    San Antonio Metropolitan Helath District Epidemiology Program. Bexar County Behavioral Risk Factor Surveillance System Data Report 2016: City of San Antonio Metropolitan Health District 2016.Google Scholar
  39. 39.
    Abraido-Lanza AF, Chao MT, Florez KR. Do healthy behaviors decline with greater acculturation? Implications for the Latino mortality paradox. Soc Sci Med. 2005;61(6):1243–55.CrossRefGoogle Scholar
  40. 40.
    Hogg R, Samji H, Cescon A, Modur S, Napravnik S, Martin J, Gill J, Klein M, Kirk G, Gange S, The North American AIDS Cohort Collaboration on Res and Design (NA-ACCORD) of IeDEA, editors. Temporal changes in life expectancy of HIV + individuals: North America. In: 19th Conference on Retroviruses and Opportunistic Infections; 2012 March 5–8; Seattle, WA.Google Scholar
  41. 41.
    Smith CJ, Ryom L, Weber R, Morlat P, Pradier C, Reiss P, Kowalska JD, de Wit S, Law M, el Sadr W, Kirk O, Friis-Moller N, Monforte A, Phillips AN, Sabin CA, Lundgren JD, Group DADS. Trends in underlying causes of death in people with HIV from 1999 to 2011 (D:A:D): a multicohort collaboration. Lancet. 2014;384(9939):241–8.CrossRefGoogle Scholar
  42. 42.
    Freiberg MS, Chang CC, Kuller LH, Skanderson M, Lowy E, Kraemer KL, Butt AA, Bidwell Goetz M, Leaf D, Oursler KA, Rimland D, Rodriguez Barradas M, Brown S, Gibert C, McGinnis K, Crothers K, Sico J, Crane H, Warner A, Gottlieb S, Gottdiener J, Tracy RP, Budoff M, Watson C, Armah KA, Doebler D, Bryant K, Justice AC. HIV infection and the risk of acute myocardial infarction. JAMA Intern Med. 2013;173(8):614–22.CrossRefGoogle Scholar
  43. 43.
    Paisible AL, Chang CC, So-Armah KA, Butt AA, Leaf DA, Budoff M, Rimland D, Bedimo R, Goetz MB, Rodriguez-Barradas MC, Crane HM, Gibert CL, Brown ST, Tindle HA, Warner AL, Alcorn C, Skanderson M, Justice AC, Freiberg MS. HIV infection, cardiovascular disease risk factor profile, and risk for acute myocardial infarction. J Acquir Immune Defic Syndr. 2015;68(2):209–16.CrossRefGoogle Scholar
  44. 44.
    Sackoff JE, Hanna DB, Pfeiffer MR, Torian LV. Causes of death among persons with AIDS in the era of highly active antiretroviral therapy: New York City. Ann Intern Med. 2006;145(6):397–406.CrossRefGoogle Scholar
  45. 45.
    Hanna DB, Ramaswamy C, Kaplan RC, Zimmerman R, Braunstein SL, editors. Cardiovascular disease mortality among HIV-infected Persons, New York City, 2001–2012. In: Conference on Retroviruses and Opportunistic Infections; 2015 February 23–26, 2015; Seattle, Washington.Google Scholar
  46. 46.
    Klein DB, Leyden WA, Xu L, Chao CR, Horberg MA, Towner WJ, Hurley LB, Marcus JL, Quesenberry CP Jr, Silverberg MJ. Declining relative risk for myocardial infarction among HIV-positive compared with HIV-negative individuals with access to care. Clin Infect Dis. 2015;60(8):1278–80.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  • Yuanyuan Liang
    • 1
  • Norma S. Ketchum
    • 2
  • Barbara J. Turner
    • 3
    • 5
  • John Flores
    • 4
  • Delia Bullock
    • 5
  • Roberto Villarreal
    • 6
  • Polly H. Noël
    • 7
  • Michael T. Yin
    • 8
  • Barbara S. Taylor
    • 3
    • 5
    Email author
  1. 1.Department of Epidemiology and Public HealthUniversity of Maryland School of MedicineBaltimoreUSA
  2. 2.Department of Epidemiology and BiostatisticsUT Health San AntonioSan AntonioUSA
  3. 3.Research to Advance Community Health (ReACH) CenterUT Health San AntonioSan AntonioUSA
  4. 4.Joint Residency Program in Medicine and PediatricsUniversity of Illinois at Chicago College of MedicineChicagoUSA
  5. 5.Department of MedicineUT Health San AntonioSan AntonioUSA
  6. 6.Research and Information ManagementUniversity Health SystemSan AntonioUSA
  7. 7.Department of Family & Community MedicineUT Health San AntonioSan AntonioUSA
  8. 8.Department of MedicineColumbia University College of Physicians and SurgeonsNew YorkUSA

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