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Sex Differences in Subclinical Atherosclerosis and Systemic Immune Activation/Inflammation Among People With Human Immunodeficiency Virus in the United States
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Sex Differences in Subclinical Atherosclerosis and Systemic
Immune Activation/Inflammation Among People With
Human Immunodeficiency Virus in the United States - Download the PDF here
Performance of the pooled cohort equations and D:A:D risk
scores among individuals with HIV in a global cardiovascular
disease prevention trial: a cohort study leveraging data
from REPRIEVE - Download the PDF here
Risk estimation in HIV reveals our usual blind spots - Download the PDF here
Supplemental - Download the PDF here
Supplementary appendix - Download the PDF here
Females showed higher levels of IL-6, hs-CRP, and D-dimer and lower levels of Lp-PLA2 (P < .001 for all). Higher levels of Lp-PLA2, MCP-1, and oxLDL were associated with higher plaque (P < .02) and NC/V-P prevalence, with no differences by sex. Among females but not males, D-dimer was associated with higher prevalence of NC/V-P (interaction P = .055).
In Figure 3 below it looks like both Black men & women in high income countries had highest MACE incidence.
Conclusions
Among US PWH, females had a lower prevalence of plaque and NC/V-P, as well as differences in key immune/inflammatory biomarkers. Immune-plaque relationships differed by sex for D-dimer but not other tested parameters.
yet
"... In high-income countries (the setting where I work), calculated risks underestimate the incidence of major cardiovascular events for women and for Black people."
Overall, Black or African American men had the highest cumulative incidence of MACE over 5 years.
Among the global cohort of people with HIV in REPRIEVE, the PCE risk score underpredicted cardiovascular events in women and Black or African American men in high-income countries and overpredicted cardiovascular events in low-income and middle-income countries. Underprediction in subgroups should be considered when using the PCE risk score to guide statin prescribing for cardiovascular prevention among people with HIV in high-income countries...... stratification by enrolment region highlighted higher-than-expected rate of events for 5-year PCE risk score among people with HIV in high-income countries and lower-than-expected rate in low-income and middle-income countries ........ although the absolute benefit expected from statin therapy varies with baseline risk, pill burden, medication costs, and side-effects are expected to remain constant. This finding makes baseline risk estimation the main determinant of the risk–benefit ratio and a crucial piece of information for shared decision making.
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