Background:  Cardiovascular complications in HIV infection are accelerated and are therefore of concern. The Framingham risk score is used to predict cardiovascular events in the non-HIV-infected population. However, its application in the HIV-infected population is poorly defined. We examined the association of Framingham risk scores with surrogate markers of atherosclerosis in a carefully characterized cohort of HIV-infected adults.

Methods:  We calculated Framingham risk scores, and measured carotid intima-media thickness (c-IMT) and coronary artery calcium (CAC) in 334 Nutrition for Healthy Living (NFHL) participants. We assessed cardiovascular risk factors, HIV viral load, CD4 count, HAART use, c-IMT, and CAC for each Framingham risk subgroup (low risk vs intermediate/high risk) using χ² test for binary and Student’s t test for continuous variables. We performed multivariate logistic regression of surrogate markers by Framingham risk group.

Results:  Subjects with intermediate/high Framingham risk score were older (p <0.001), male (p <0.001), with higher serum C-reactive protein levels (p = 0.028), and a longer duration of HIV infection (p = 0.027). Patients with intermediate/high Framingham risk scores were more likely to have internal c-IMT ≥1.0 mm (21.1% vs 9.2%, p = 0.003) and common c-IMT ≥0.8 mm (16.2% vs 2.2%, p <0.001). Patients with intermediate/high Framingham risk score were also more likely to have detectable CAC (70.6% vs 41.6 %, p <0.001). In the multivariate analysis, intermediate/high Framingham risk scores were significantly associated with internal c-IMT ≥1.0 mm (OR 2.22, 1.12 to 4.43) and common c-IMT ≥0.8 mm (OR 7.07, 2.33 to 21.42). Intermediate/high Framingham risk score were also significantly associated with detectable CAC (OR 3.44, 2.11 to 5.63).

Conclusions:  Our study shows that elevated Framingham risk scores are associated with abnormal early and late surrogate markers of atherosclerosis in HIV-infected adults, and may predict the risk of cardiovascular complications in HIV-infected adults. Our findings support the use of the Framingham predictive instrument for cardiovascular risk stratification in the HIV-infected population.