Risk Prediction

  • Merle MyersonEmail author


Risk stratification is a key component of determining need for and extent of lipid therapy for patients with higher-risk patients receiving more intensive treatment. At present there is no validated risk scoring system for patients infected with HIV, and guidelines for the general population are applied to this patient population. As research has shown that patients living with HIV are at increased risk for cardiovascular disease, it is felt that HIV status should be considered in assessing risk. The National Lipid Association has issued recommendations for management of dyslipidemia in patients infected with HIV. Guidelines and risk stratification schemes for the general population should be followed with the added recommendation that “HIV infection may be counted as an additional ASCVD risk factor for risk stratification.”


Risk stratification Risk factors Lipid goals and targets Framingham Risk Score Pooled cohort equations NCEP-ATP III 


  1. 1.
    Third Report of the National Cholesterol Education Program (NCEP) Expert panel on detection, evaluation, and treatment of high blood cholesterol in adults (adult treatment panel III) final report. Circulation. 2002; 106(25):3143–421.Google Scholar
  2. 2.
    Stone NJ, et al. 2013 ACC/AHA guideline on the treatment of blood cholesterol to reduce atherosclerotic cardiovascular risk in adults: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol. 2014:63:2889–934.Google Scholar
  3. 3.
    Ginsberg HN. The 2013 ACC/AHA guidelines on the treatment of blood cholesterol: questions, questions, questions. Circ Res. 2014;114(5):761–4.CrossRefGoogle Scholar
  4. 4.
    Jacobson TA, et al. National Lipid Association recommendations for patient-centered management of dyslipidemia: part 1 – executive summary. J Clin Lipidol. 2014;8(5):473–88.CrossRefGoogle Scholar
  5. 5.
    Friis-Moller N, et al. 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
  6. 6.
    Justice AC, et al. Does an index composed of clinical data reflect effects of inflammation, coagulation, and monocyte activation on mortality among those aging with HIV? Clin Infect Dis. 2012;54(7):984–94.CrossRefGoogle Scholar
  7. 7.
    Aberg JA, et al. Primary care guidelines for the management of persons infected with HIV: 2013 update by the HIV medicine association of the Infectious Diseases Society of America. Clin Infect Dis. 2014;58(1):e1–34.CrossRefGoogle Scholar
  8. 8.
    Lundgren JD, et al. European AIDS Clinical Society (EACS) guidelines on the prevention and management of metabolic diseases in HIV. HIV Med. 2008;9(2):72–81.CrossRefGoogle Scholar
  9. 9.
    Falcone EL, et al. Framingham risk score and early markers of atherosclerosis in a cohort of adults infected with HIV. Antivir Ther. 2011;16(1):1–8.CrossRefGoogle Scholar
  10. 10.
    Parra S, et al. Nonconcordance between subclinical atherosclerosis and the calculated Framingham risk score in HIV-infected patients: relationships with serum markers of oxidation and inflammation. HIV Med. 2010;11(4):225–31.CrossRefGoogle Scholar
  11. 11.
    Law MG, et al. The use of the Framingham equation to predict myocardial infarctions in HIV-infected patients: comparison with observed events in the D:A:D Study. HIV Med. 2006;7(4):218–30.CrossRefGoogle Scholar
  12. 12.
    Zanni MV, et al. 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
  13. 13.
    Martin SS, Blumenthal RS. Concepts and controversies: the 2013 American College of Cardiology/American Heart Association risk assessment and cholesterol treatment guidelines. Ann Intern Med. 2014;160(5):356–8.CrossRefGoogle Scholar
  14. 14.
    Ridker PM, Cook NR. Statins: new American guidelines for prevention of cardiovascular disease. Lancet. 2013;382(9907):1762–5.CrossRefGoogle Scholar
  15. 15.
    Hulten E, et al. HIV positivity, protease inhibitor exposure and subclinical atherosclerosis: a systematic review and meta-analysis of observational studies. Heart. 2009;95(22):1826–35.CrossRefGoogle Scholar
  16. 16.
    Hsu R, et al. Independent predictors of carotid intimal thickness differ between HIV+ and HIV- patients with respect to traditional cardiac risk factors, risk calculators, lipid subfractions, and inflammatory markers. In 7th International AIDS conference on HIV pathogenesis, treatment, and prevention. Kuala Lumpur, Malaysia 2013.Google Scholar
  17. 17.
    Post WS, et al. Associations between HIV infection and subclinical coronary atherosclerosis. Ann Intern Med. 2014;160(7):458–67.CrossRefGoogle Scholar
  18. 18.
    Fichtenbaum CJ, et al. Treatment with pravastatin and fenofibrate improves atherogenic lipid profiles but not inflammatory markers in ACTG 5087. J Clin Lipidol. 2010;4(4):279–87.CrossRefGoogle Scholar
  19. 19.
    Shikuma CM, et al. Change in high-sensitivity c-reactive protein levels following initiation of efavirenz-based antiretroviral regimens in HIV-infected individuals. AIDS Res Hum Retrovir. 2011;27(5):461–8.CrossRefGoogle Scholar
  20. 20.
    Silverberg MJ, et al. Response to newly prescribed lipid-lowering therapy in patients with and without HIV infection. Ann Intern Med. 2009;150(5):301–13.CrossRefGoogle Scholar
  21. 21.
    Jacobson TA, et al. National lipid association recommendations for patient-centered management of dyslipidemia: part 2. J Clin Lipidol. 2015;9(6 Suppl):S1–S122.e1.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.Division of Cardiology, Bassett Medical CenterBassett Research Institute, Center for Clinical ResearchCooperstownUSA

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