Abstract
Background: REPRIEVE findings catalyzed changes to multiple guidelines directing statin therapy prescribing for people with HIV (PWH). US guidelines use the Pooled Cohort Equations (PCE)-derived 10-year ASCVD risk score but may in the future incorporate the new PREVENT score. Meanwhile, European guidelines use SCORE2.
Methods: Leveraging 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 7,757 participants with data for PREVENT and SCORE2 calculation. 10-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 re-classified 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 (MACE)/1000 person years (PY) was higher than that predicted by PREVENT, except for those with ultra-low predicted risk. 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] versus 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.