| Publication Abstract Display | | Type: Published Abstract | | Title: Application of the Framingham Stroke Risk Calculator to a stroke-free sample of HIV+ adults. | | Authors: Ellis R, Croteau D, Riggs P, Letendre S, Delano-Wood L, Deutsch R, Woods SP | | Year: 2011 | | Publication: 6th IAS Conference on HIV Pathogenesis, Treatment and Prevention | | Volume: Issue: Pages: | | Abstract:Background: In previous population-based studies of healthy older adults, increasing Framingham stroke risk scores, a potential marker of subclinical cerebrovascular disease, correlate with poorer cognitive performance, regardless of whether a clinical stroke has actually occurred. Cognitive impairment in older HIV+ individuals has been reported to correlate with vascular risk factors such as diabetes mellitus and dyslipidemia, but the relationship of cognitive impairment to Framingham stroke risk in HIV+ has not been characterized.
Methods: Younger (18-40 years) and older (50-71 years) HIV+ and HIV- research volunteers group-matched on age, education and race/ethnicity underwent standardized and well-validated neurological and neuropsychological evaluations. Five-year stroke risk was estimated based on data from the Framingham registry. Prospective memory, a cognitive ability often impaired in HIV, was measured by the Memory for Intentions Screening Test (MIST).
Results: Framingham 5-year stroke risk estimates were elevated in HIV+ (n=117) compared to age- and ethnicity-matched HIV- individuals (n=100) (median [IQR] 1.2 [0.5, 2.2] vs. 0.8 [0.3, 1.6] Wilcoxon p <0.0054). Evaluation of age subgroups (older versus younger) revealed that this difference was primarily due to higher stroke risk scores in older HIV+ (OH; n=75) vs older HIV- (ON; n=52) (1.9 [1.1, 2.7] vs. 1.6 [0.8, 2.5]; p = 0.086), but not younger subjects (0.4 [0.3, 0.6] vs 0.4 [0.1, 0.6]; p=0.34). The principal determinants of differences in stroke risk scores for OH were ongoing treatment for hypertension (40.0% vs 15.4%; OR 3.7 [95% CI 1.52, 8.9]; p=0.002) and diabetes mellitus (17.3% vs 5.7%; OR 3.4 [0.9, 12.7]; p=0.044). Demographically-adjusted global neurocognitive performance was more frequently impaired (NPI) in HIV+ vs HIV- individuals, with the highest rates of impairment evident in OH (YH 29%; YN 21%; OH 39%; ON 23%). The excess prevalence of NPI in OH was not related to stroke risk score. After adjusting for age, increasing stroke risk scores across all study participants showed a trend for association with worse performance on the MIST summary score (partial r=0.12; p=0.08). The relationship of stroke risk to MIST was similar in HIV+ and HIV- subjects.
Summary: Stroke risk estimated by the Framingham risk calculator was modestly increased in older HIV+ as compared to HIV- individuals, principally due to an excess of hypertension and diabetes mellitus. However, stroke risk scores in HIV+ were not independently related to cognitive impairment, beyond consideration of HIV infection and age. |
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