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Vascular Age Exceeds Actual Age in HIV-Positive Men in Metabolic Clinic
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3rd International Workshop on HIV and Aging, November 5-6, 2012, Baltimore
Mark Mascolini
Vascular age calculated by the old and new Framingham Risk Score formulas exceeded actual chronologic age in 1432 HIV-positive men being seen at a metabolic clinic in Modena, Italy [1]. Among 50- to 59-year-old men, median vascular age eclipsed median actual age by 9 years according to the old Framingham formula and by 13 years according to the new Framingham formula.
Early cardiovascular disease remains a substantial threat to HIV-positive people. The Framingham Risk Score (FRS), updated in 2008 [2], is one tool recommended to calculate cardiovascular risk in HIV-positive people. FRS can also be used to figure vascular age, defined as the "chronologic age of a person with the same predicted risk but all risk factors normal." Research by one of investigators, Julian Falutz (McGill University), found that switching from the old FRS calculator to the new one moved 36 of 106 HIV-positive people (34%) into a higher cardiovascular risk bracket.
Collaborators in Montreal, Modena, and Philadelphia used the 2008 and 2001 FRS (FRS-new and FRS-old) to calculate vascular age retrospectively in 1432 HIV-positive men cared for between 2005 and 2010 in Modena's HIV metabolic clinic and stratified into four age groups: 18-39 (n = 222), 40-49 (n = 868), 50-59 (n = 272), and 60-75 (n = 70). The study group was predominantly Caucasian, had a median age of 45, and had HIV infection for a median of 172 months. CD4 count averaged 528, and 59% of men had a viral load below 50 copies. Overall, half of the men smoked, but smoking prevalence was lower in the 50-to-59 group (37%) and the 60-to-75 group (22%).
For each age group, median actual age was significantly younger than vascular age with both FRS formulas (P = 0.000 for all actual vs vascular comparisons):
18-39: Actual 36, vascular with FRS-old 43 (+7), vascular with FRS-new 41 (+5), old vs new P = 0.0008
40-49: Actual 44, vascular with FRS-old 54 (+10), vascular with FRS-new 54 (+10)
50-59: Actual 53, vascular with FRS-old 62 (+9), vascular with FRS-new 66 (+13), old vs new P = 0.0000
60-75: Actual 64, vascular with FRS-old 67 (+3), vascular with FRS-new 76 (+16), old vs new P= 0.0000
Although the new Framingham formula calculated significantly older vascular age than the old formula for men over 50, ten studies of cardiovascular risk in HIV-positive people published since the new score became available used the old score.
The investigators noted that their analysis did not include HIV-negative people, so they could not determine the impact of HIV alone on vascular age in these men. But they proposed that "differences between vascular and chronologic age represent an increased cardiovascular risk in all age groups of these HIV patients." The researchers believe their findings suggest that "accelerated cardiac ageing is common and must be aggressively evaluated."
References
1. Falutz J, Benamu E, Rosenthall L, Guaraldi G. Accelerated cardiovascular ageing in treated HIV males: impact of the Framingham Risk Score on the difference between chronologic and vascular age. 3rd International Workshop on HIV and Aging. November 5-6, 2012, Baltimore. Abstract O_15.
2. D'Agostino RB Sr, Vasan RS, Pencina MJ, et al. General cardiovascular risk profile for use in primary care: the Framingham Heart Study. Circulation. 2008;117:743-753. http://circ.ahajournals.org/content/117/6/743.long.
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