Farrah J Mateen1, Wendy S Post, Ned Sacktor, Alison G Abraham, James T Becker, Bryan R Smith, Roger Detels, Eileen Martin, John P Phair, Russell T Shinohara. 1. From the Department of Neurology (F.J.M.), Massachusetts General Hospital, Boston; Departments of International Health (F.J.M., N.S.), and Epidemiology (W.S.P., A.G.A.), Bloomberg School of Public Health, and Department of Medicine, Division of Cardiology (W.S.P.), the Johns Hopkins University, Baltimore; Department of Neurology (N.S., B.R.S.), the Johns Hopkins Hospital, Baltimore, MD; Departments of Neurology, Psychiatry, and Psychology (J.T.B.), University of Pittsburgh, PA; Department of Epidemiology, School of Public Health (R.D.), and Department of Medicine, School of Medicine (R.D.), University of California, Los Angeles; Department of Psychiatry (E.M.), Rush University Medical Center, Chicago; Feinberg School of Medicine (J.P.P.), Division of Infectious Diseases, Northwestern University, Chicago, IL; and Department of Biostatistics and Epidemiology (R.T.S.), Perelman School of Medicine, University of Pennsylvania, Philadelphia.
Abstract
OBJECTIVE: To test the predictive accuracy of the Framingham Risk Score for Stroke (FRS-S) in HIV-infected (HIV+) vs HIV-uninfected (HIV-) men. METHODS: The Multicenter AIDS Cohort Study (MACS) is an ongoing prospective study of HIV+ and HIV- men who have sex with men (MSM) enrolled in 4 US cities. We ascertained all reported stroke events during a recent 15-year timeframe (July 1, 1996 to June 30, 2011) among 3,945 participants (1,776 HIV+ and 2,169 HIV-). For those with strokes, FRS-S were calculated 10 years before the stroke event and assessed according to HIV status. RESULTS: A total of 114 stroke events occurred, including 57 HIV+ and 37 HIV- participants with first-ever strokes and 19 fatal strokes. The incidence of first-ever stroke was 1.7/1,000 person-years among HIV- and 3.3/1,000 person-years among HIV+ participants. Among those with strokes, HIV+ participants were younger than HIV- participants (median age 51.3 vs 61.8 years, p < 0.0001). For these men with stroke, the average 10-year risk of stroke was higher for HIV- MSM (6.6% [range 3%-26%] vs 4.9% for HIV+ MSM [range 0%-15%], p < 0.04). Traditional risk factors for stroke were similar among the Framingham cohort and the MACS HIV+ and HIV- participants. CONCLUSIONS: FRS-S prediction was systematically different in HIV+ vs HIV- men with stroke events. The FRS-S underestimates the long-term risk of stroke in HIV+ men.
OBJECTIVE: To test the predictive accuracy of the Framingham Risk Score for Stroke (FRS-S) in HIV-infected (HIV+) vs HIV-uninfected (HIV-) men. METHODS: The Multicenter AIDS Cohort Study (MACS) is an ongoing prospective study of HIV+ and HIV- men who have sex with men (MSM) enrolled in 4 US cities. We ascertained all reported stroke events during a recent 15-year timeframe (July 1, 1996 to June 30, 2011) among 3,945 participants (1,776 HIV+ and 2,169 HIV-). For those with strokes, FRS-S were calculated 10 years before the stroke event and assessed according to HIV status. RESULTS: A total of 114 stroke events occurred, including 57 HIV+ and 37 HIV- participants with first-ever strokes and 19 fatal strokes. The incidence of first-ever stroke was 1.7/1,000 person-years among HIV- and 3.3/1,000 person-years among HIV+ participants. Among those with strokes, HIV+ participants were younger than HIV- participants (median age 51.3 vs 61.8 years, p < 0.0001). For these men with stroke, the average 10-year risk of stroke was higher for HIV- MSM (6.6% [range 3%-26%] vs 4.9% for HIV+ MSM [range 0%-15%], p < 0.04). Traditional risk factors for stroke were similar among the Framingham cohort and the MACS HIV+ and HIV- participants. CONCLUSIONS: FRS-S prediction was systematically different in HIV+ vs HIV- men with stroke events. The FRS-S underestimates the long-term risk of stroke in HIV+ men.
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