Characterization and risk stratification of coronary artery disease in people living with HIV: a global systematic review

Coronary artery disease (CAD) is a leading cause of mortality among people living with HIV (PLWH). Risk stratification remains inconsistent due to geographic disparities, ART-related metabolic effects, and overreliance on strength of association. This review synthesizes global evidence to classify C...

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Vydané v:Frontiers in cardiovascular medicine Ročník 12; s. 1586019
Hlavní autori: Nweke, Martins, Ibeneme, Sam, Pillay, Julian D., Mshunqane, Nombeko
Médium: Journal Article
Jazyk:English
Vydavateľské údaje: Switzerland Frontiers Media S.A 12.08.2025
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Abstract Coronary artery disease (CAD) is a leading cause of mortality among people living with HIV (PLWH). Risk stratification remains inconsistent due to geographic disparities, ART-related metabolic effects, and overreliance on strength of association. This review synthesizes global evidence to classify CAD risk factors in PLWH, aiming to improve predictive models and preventative strategies. Following the PRISMA 2020 guidelines, a systematic review was conducted across six databases: PubMed, Scopus, Web of Science, Medline, CINAHL, and African Journals (SABINET). Two independent reviewers screened studies and extracted data. Narrative synthesis and meta-analysis were conducted. Risk factors were classified using Rw, causality index (CI), and public health priority (PHP). Twenty-two studies involving 103,370 participants were included. First-class risk factors (CI: 7-10) included hypertension (OR: 4.9;  < 0.05; Rw: 4.5), advanced age (≥50 years) (OR: 4.96,  < 0.05, Rw: 3.58), dyslipidemia (OR: 2.15,  < 0.04, Rw: 2.15), and overweight/obesity (OR: 1.81,  < 0.05, Rw: 1.36). Second-class risk factors (CI: 5-6) included family history of CVD (OR: 3.25,  < 0.05; Rw: 2. 24). Third-class risk factors (CI ≤4) included diabetes (OR: 2.64,  < 0.05, Rw: 1.32), antiretroviral therapy exposure (OR: 1.68,  < 0.05, Rw: 0.63), and homosexuality (OR: 1.82,  < 0.05, Rw: 0.62). Critical thresholds (cumulative Rw: 14.8 and 8.0) were set at 75th and 50th percentiles of cumulative Rw. At GTT value of 0.50, the parsimonious global clinical prediction model for HIV-related CAD included age, hypertension, dyslipidemia, family history of CVD, diabetes, and overweight/obesity (Rw: 15.5, GTT: 4.05). For primary prevention, the optimal model comprised hypertension, dyslipidemia, and obesity (Rw: 8.01, GTT: 2.07). Advanced age and hypertension were "necessary causes" of CAD among PLWH. Association strength alone cannot determine CAD risk. Cumulative risk indexing and responsiveness provide a robust framework. Prevention should prioritize hypertension and dyslipidemia management, with interventions for obesity, smoking, and virological failure. Age and hypertension should prompt cardiovascular screening. Standardized risk definitions, accounting for the role of protective factors and integrating evidence with domain knowledge are vital for improved CAD risk stratification and prediction in PLWH. Routine cardiovascular screening in HIV care remains essential. https://www.crd.york.ac.uk/PROSPERO/view/CRD42024524494, PROSPERO CRD42024524494.
AbstractList Coronary artery disease (CAD) is a leading cause of mortality among people living with HIV (PLWH). Risk stratification remains inconsistent due to geographic disparities, ART-related metabolic effects, and overreliance on strength of association. This review synthesizes global evidence to classify CAD risk factors in PLWH, aiming to improve predictive models and preventative strategies.BackgroundCoronary artery disease (CAD) is a leading cause of mortality among people living with HIV (PLWH). Risk stratification remains inconsistent due to geographic disparities, ART-related metabolic effects, and overreliance on strength of association. This review synthesizes global evidence to classify CAD risk factors in PLWH, aiming to improve predictive models and preventative strategies.Following the PRISMA 2020 guidelines, a systematic review was conducted across six databases: PubMed, Scopus, Web of Science, Medline, CINAHL, and African Journals (SABINET). Two independent reviewers screened studies and extracted data. Narrative synthesis and meta-analysis were conducted. Risk factors were classified using Rw, causality index (CI), and public health priority (PHP).MethodsFollowing the PRISMA 2020 guidelines, a systematic review was conducted across six databases: PubMed, Scopus, Web of Science, Medline, CINAHL, and African Journals (SABINET). Two independent reviewers screened studies and extracted data. Narrative synthesis and meta-analysis were conducted. Risk factors were classified using Rw, causality index (CI), and public health priority (PHP).Twenty-two studies involving 103,370 participants were included. First-class risk factors (CI: 7-10) included hypertension (OR: 4.9; p < 0.05; Rw: 4.5), advanced age (≥50 years) (OR: 4.96, p < 0.05, Rw: 3.58), dyslipidemia (OR: 2.15, p < 0.04, Rw: 2.15), and overweight/obesity (OR: 1.81, p < 0.05, Rw: 1.36). Second-class risk factors (CI: 5-6) included family history of CVD (OR: 3.25, p < 0.05; Rw: 2. 24). Third-class risk factors (CI ≤4) included diabetes (OR: 2.64, p < 0.05, Rw: 1.32), antiretroviral therapy exposure (OR: 1.68, p < 0.05, Rw: 0.63), and homosexuality (OR: 1.82, p < 0.05, Rw: 0.62). Critical thresholds (cumulative Rw: 14.8 and 8.0) were set at 75th and 50th percentiles of cumulative Rw. At GTT value of 0.50, the parsimonious global clinical prediction model for HIV-related CAD included age, hypertension, dyslipidemia, family history of CVD, diabetes, and overweight/obesity (Rw: 15.5, GTT: 4.05). For primary prevention, the optimal model comprised hypertension, dyslipidemia, and obesity (Rw: 8.01, GTT: 2.07). Advanced age and hypertension were "necessary causes" of CAD among PLWH.FindingsTwenty-two studies involving 103,370 participants were included. First-class risk factors (CI: 7-10) included hypertension (OR: 4.9; p < 0.05; Rw: 4.5), advanced age (≥50 years) (OR: 4.96, p < 0.05, Rw: 3.58), dyslipidemia (OR: 2.15, p < 0.04, Rw: 2.15), and overweight/obesity (OR: 1.81, p < 0.05, Rw: 1.36). Second-class risk factors (CI: 5-6) included family history of CVD (OR: 3.25, p < 0.05; Rw: 2. 24). Third-class risk factors (CI ≤4) included diabetes (OR: 2.64, p < 0.05, Rw: 1.32), antiretroviral therapy exposure (OR: 1.68, p < 0.05, Rw: 0.63), and homosexuality (OR: 1.82, p < 0.05, Rw: 0.62). Critical thresholds (cumulative Rw: 14.8 and 8.0) were set at 75th and 50th percentiles of cumulative Rw. At GTT value of 0.50, the parsimonious global clinical prediction model for HIV-related CAD included age, hypertension, dyslipidemia, family history of CVD, diabetes, and overweight/obesity (Rw: 15.5, GTT: 4.05). For primary prevention, the optimal model comprised hypertension, dyslipidemia, and obesity (Rw: 8.01, GTT: 2.07). Advanced age and hypertension were "necessary causes" of CAD among PLWH.Association strength alone cannot determine CAD risk. Cumulative risk indexing and responsiveness provide a robust framework. Prevention should prioritize hypertension and dyslipidemia management, with interventions for obesity, smoking, and virological failure. Age and hypertension should prompt cardiovascular screening. Standardized risk definitions, accounting for the role of protective factors and integrating evidence with domain knowledge are vital for improved CAD risk stratification and prediction in PLWH. Routine cardiovascular screening in HIV care remains essential.ConclusionAssociation strength alone cannot determine CAD risk. Cumulative risk indexing and responsiveness provide a robust framework. Prevention should prioritize hypertension and dyslipidemia management, with interventions for obesity, smoking, and virological failure. Age and hypertension should prompt cardiovascular screening. Standardized risk definitions, accounting for the role of protective factors and integrating evidence with domain knowledge are vital for improved CAD risk stratification and prediction in PLWH. Routine cardiovascular screening in HIV care remains essential.https://www.crd.york.ac.uk/PROSPERO/view/CRD42024524494, PROSPERO CRD42024524494.Systematic Review Registrationhttps://www.crd.york.ac.uk/PROSPERO/view/CRD42024524494, PROSPERO CRD42024524494.
Coronary artery disease (CAD) is a leading cause of mortality among people living with HIV (PLWH). Risk stratification remains inconsistent due to geographic disparities, ART-related metabolic effects, and overreliance on strength of association. This review synthesizes global evidence to classify CAD risk factors in PLWH, aiming to improve predictive models and preventative strategies. Following the PRISMA 2020 guidelines, a systematic review was conducted across six databases: PubMed, Scopus, Web of Science, Medline, CINAHL, and African Journals (SABINET). Two independent reviewers screened studies and extracted data. Narrative synthesis and meta-analysis were conducted. Risk factors were classified using Rw, causality index (CI), and public health priority (PHP). Twenty-two studies involving 103,370 participants were included. First-class risk factors (CI: 7-10) included hypertension (OR: 4.9;  < 0.05; Rw: 4.5), advanced age (≥50 years) (OR: 4.96,  < 0.05, Rw: 3.58), dyslipidemia (OR: 2.15,  < 0.04, Rw: 2.15), and overweight/obesity (OR: 1.81,  < 0.05, Rw: 1.36). Second-class risk factors (CI: 5-6) included family history of CVD (OR: 3.25,  < 0.05; Rw: 2. 24). Third-class risk factors (CI ≤4) included diabetes (OR: 2.64,  < 0.05, Rw: 1.32), antiretroviral therapy exposure (OR: 1.68,  < 0.05, Rw: 0.63), and homosexuality (OR: 1.82,  < 0.05, Rw: 0.62). Critical thresholds (cumulative Rw: 14.8 and 8.0) were set at 75th and 50th percentiles of cumulative Rw. At GTT value of 0.50, the parsimonious global clinical prediction model for HIV-related CAD included age, hypertension, dyslipidemia, family history of CVD, diabetes, and overweight/obesity (Rw: 15.5, GTT: 4.05). For primary prevention, the optimal model comprised hypertension, dyslipidemia, and obesity (Rw: 8.01, GTT: 2.07). Advanced age and hypertension were "necessary causes" of CAD among PLWH. Association strength alone cannot determine CAD risk. Cumulative risk indexing and responsiveness provide a robust framework. Prevention should prioritize hypertension and dyslipidemia management, with interventions for obesity, smoking, and virological failure. Age and hypertension should prompt cardiovascular screening. Standardized risk definitions, accounting for the role of protective factors and integrating evidence with domain knowledge are vital for improved CAD risk stratification and prediction in PLWH. Routine cardiovascular screening in HIV care remains essential. https://www.crd.york.ac.uk/PROSPERO/view/CRD42024524494, PROSPERO CRD42024524494.
BackgroundCoronary artery disease (CAD) is a leading cause of mortality among people living with HIV (PLWH). Risk stratification remains inconsistent due to geographic disparities, ART-related metabolic effects, and overreliance on strength of association. This review synthesizes global evidence to classify CAD risk factors in PLWH, aiming to improve predictive models and preventative strategies.MethodsFollowing the PRISMA 2020 guidelines, a systematic review was conducted across six databases: PubMed, Scopus, Web of Science, Medline, CINAHL, and African Journals (SABINET). Two independent reviewers screened studies and extracted data. Narrative synthesis and meta-analysis were conducted. Risk factors were classified using Rw, causality index (CI), and public health priority (PHP).FindingsTwenty-two studies involving 103,370 participants were included. First-class risk factors (CI: 7–10) included hypertension (OR: 4.9; p < 0.05; Rw: 4.5), advanced age (≥50 years) (OR: 4.96, p < 0.05, Rw: 3.58), dyslipidemia (OR: 2.15, p < 0.04, Rw: 2.15), and overweight/obesity (OR: 1.81, p < 0.05, Rw: 1.36). Second-class risk factors (CI: 5–6) included family history of CVD (OR: 3.25, p < 0.05; Rw: 2. 24). Third-class risk factors (CI ≤4) included diabetes (OR: 2.64, p < 0.05, Rw: 1.32), antiretroviral therapy exposure (OR: 1.68, p < 0.05, Rw: 0.63), and homosexuality (OR: 1.82, p < 0.05, Rw: 0.62). Critical thresholds (cumulative Rw: 14.8 and 8.0) were set at 75th and 50th percentiles of cumulative Rw. At GTT value of 0.50, the parsimonious global clinical prediction model for HIV-related CAD included age, hypertension, dyslipidemia, family history of CVD, diabetes, and overweight/obesity (Rw: 15.5, GTT: 4.05). For primary prevention, the optimal model comprised hypertension, dyslipidemia, and obesity (Rw: 8.01, GTT: 2.07). Advanced age and hypertension were “necessary causes” of CAD among PLWH.ConclusionAssociation strength alone cannot determine CAD risk. Cumulative risk indexing and responsiveness provide a robust framework. Prevention should prioritize hypertension and dyslipidemia management, with interventions for obesity, smoking, and virological failure. Age and hypertension should prompt cardiovascular screening. Standardized risk definitions, accounting for the role of protective factors and integrating evidence with domain knowledge are vital for improved CAD risk stratification and prediction in PLWH. Routine cardiovascular screening in HIV care remains essential.Systematic Review Registrationhttps://www.crd.york.ac.uk/PROSPERO/view/CRD42024524494, PROSPERO CRD42024524494.
Author Ibeneme, Sam
Nweke, Martins
Pillay, Julian D.
Mshunqane, Nombeko
AuthorAffiliation 3 Department of Physiotherapy, David Umahi Federal University of Health Sciences , Uburu, Ebonyi , Nigeria
2 Global Health and Sustainability, Faculty of Health Sciences, Durban University of Technology , Durban , South Africa
1 Department of Physiotherapy, Faculty of Health Sciences, University of Pretoria , Pretoria , South Africa
AuthorAffiliation_xml – name: 3 Department of Physiotherapy, David Umahi Federal University of Health Sciences , Uburu, Ebonyi , Nigeria
– name: 2 Global Health and Sustainability, Faculty of Health Sciences, Durban University of Technology , Durban , South Africa
– name: 1 Department of Physiotherapy, Faculty of Health Sciences, University of Pretoria , Pretoria , South Africa
Author_xml – sequence: 1
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  givenname: Julian D.
  surname: Pillay
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  givenname: Nombeko
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Keywords coronary artery disease
epidemiological model
risk stratification
HIV
systematic review
Language English
License 2025 Nweke, Ibeneme, Pillay and Mshunqane.
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Snippet Coronary artery disease (CAD) is a leading cause of mortality among people living with HIV (PLWH). Risk stratification remains inconsistent due to geographic...
BackgroundCoronary artery disease (CAD) is a leading cause of mortality among people living with HIV (PLWH). Risk stratification remains inconsistent due to...
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SubjectTerms Cardiovascular Medicine
coronary artery disease
epidemiological model
HIV
risk stratification
systematic review
Title Characterization and risk stratification of coronary artery disease in people living with HIV: a global systematic review
URI https://www.ncbi.nlm.nih.gov/pubmed/40873612
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https://pubmed.ncbi.nlm.nih.gov/PMC12378808
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