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Cardiovascular risk assessment in persons with HIV in the developing world: comparing three risk equations in a cohort of HIV-infected Thais

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Journal of the International AIDS Society201013 (Suppl 4) :O40

  • Published:


  • Coronary Heart Disease
  • Risk Score
  • Framingham Risk Score
  • High Cardiovascular Risk
  • Risk Equation


There are growing concerns of cardiovascular disease in HIV-infected individuals and in developing countries, such as Thailand. We described the ten-year risk of coronary heart disease (CHD) in a Thai HIV-infected cohort using 3 cardiovascular risk equations, and assessed the level of agreement between their predictions.


Cross-sectional analysis of data from 785 Thai subjects followed prospectively in the HIV Netherlands Australia Thailand Collaboration (HIV-NAT) cohort study from 1996-2009. Cardiovascular risk factor history, along with relevant laboratory and clinical data, was collected at follow-up clinic visits. Ten-year risks of CHD were calculated using the Framingham, Ramathibodi-Electricity Generating Authority of Thailand (Rama-EGAT), and Data-collection on Adverse Effects of Anti-HIV Drugs (D:A:D) risk equations.


Mean age was 41.0 years; 55% of subjects were male. Mean CD4 count was 569 cells/mm3 after a mean of 7.7 years on anti-retroviral therapy. The prevalence of cardiovascular risk factors was low, with the most common risk factor being low high density lipoprotein (36.3%). The prevalence of high cardiovascular risk scores (defined as ten-year risk of CHD ≥10%) was also low: 9.9%, 2.1%, and 0.8%, by the Framingham, Rama-EGAT, and D:A:D scoring systems, respectively. Only 8 subjects (1.0%) had a history of CHD. Bland-Altman plots revealed that the Framingham risk score was, on average, 1.4% (S.D. 3.9%) higher than the Rama-EGAT and 1.5% (S.D. 3.7%) higher than the D:A:D (Figure 1a,b). The limits of the difference showed that the Framingham could be as high as 9.1% above or as low as 6.4% below the Rama-EGAT, and as high as 8.9% above or as low as 5.9% below the D:A:D. The Bland-Altman plot comparing the D:A:D and Rama-EGAT equations (Figure 1c) demonstrated a smaller average difference (-0.16%) and narrower limits of the difference (-3.9% and 3.5%). All differences were most pronounced for subjects with higher average risk scores.

Figure 1


The predicted cardiovascular risk in this HIV-infected Thai cohort was relatively low. The Framingham equation predicted the highest cardiovascular risks, which is consistent with its known tendency to over-predict risk in Thais. The agreement between the Rama-EGAT and D:A:D risk scores suggests that both equations may be appropriate estimators of cardiovascular risk in this and other developing world populations with low background risk.

Authors’ Affiliations

Columbia University College of Physicians & Surgeons, New York, USA
The HIV Netherlands Australia Thailand Research Collaboration, The Thai Red Cross AIDS Research Center, Bangkok, Thailand
South East Asia Research Collaboration with Hawaii, Bangkok, Thailand, Bangkok, Thailand


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© Edwards-Jackson et al; licensee BioMed Central Ltd. 2010

This article is published under license to BioMed Central Ltd. This is an open access article distributed under the terms of the Creative Commons Attribution License (, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.