Cardiovascular risk score associations with frailty in men and women with or at risk for HIV

Mark H. Kuniholm; Elizabeth Vasquez; Allison A. Appleton; Lawrence Kingsley; Frank J. Palella; Matthew Budoff; Erin D. Michos; Ervin Fox; Deborah Jones; Adaora A. Adimora; Igho Ofotokun; Gypsyamber D’souza; Kathleen M. Weber; Phyllis C. Tien; Michael Plankey; Anjali Sharma; Deborah R. Gustafson

doi:10.1097/QAD.0000000000003107

Cardiovascular risk score associations with frailty in men and women with or at risk for HIV

Mark H. Kuniholm^*, Elizabeth Vasquez, Allison A. Appleton, Lawrence Kingsley, Frank J. Palella, Matthew Budoff, Erin D. Michos, Ervin Fox, Deborah Jones, Adaora A. Adimora, Igho Ofotokun, Gypsyamber D’souza, Kathleen M. Weber, Phyllis C. Tien, Michael Plankey, Anjali Sharma, Deborah R. Gustafson

^*Corresponding author for this work

Medicine, Infectious Diseases Division

Research output: Contribution to journal › Article › peer-review

4 Scopus citations

Abstract

Objective: To understand the relationship between cardiovascular disease (CVD) risk and frailty among men (MWH) and women living with HIV (WWH), or at risk for HIV. Design: We considered 10-year coronary heart disease and atherosclerotic CVD risk by Framingham risk score (FRS, 2001 National Cholesterol Education Program Adult Treatment Program III) and Pooled Cohort Equations (PCE, 2013 American College of Cardiology/American Heart Association) in relation to the Fried Frailty Phenotype (FFP) in the Multicenter AIDS Cohort Study (MACS) and Women’s Interagency HIV Study (WIHS). Methods: FFP was ascertained in MACS from 2004 to 2019 and in WIHS from 2005 to 2006 and 2011 – 2019. FFP score at least three of five components defined frailty. Repeated measures logistic regression (both cohorts) and Cox proportional hazards regression (MACS) were performed, controlled for education, income, cholesterol medication and hepatitis C virus serostatus, and among MWH and WWH, CD4^þ cell count/ml, antiretroviral therapy, and HIV viral load. Results: There were 5554 participants (1265 HIV seronegative/1396 MWH; 768 seronegative/1924 WWH) included. Among men, high-risk FRS was associated with increased risk of incident frailty among seronegative [adjusted hazard ratio (aHR)) ¼ 2.12, 95% confidence interval (CI):1.22 – 3.69] and MWH (aHR ¼ 2.19, 95% CI: 1.33 – 3.61). Similar associations were seen with high-risk PCE and incident frailty among SN (aHR ¼ 1.88, 95% CI: 1.48 – 2.39) and MWH (aHR ¼ 1.59, 95% CI: 1.26 – 2.00). Among women, high-risk PCE was associated with frailty in SN [adjusted odds ratio (aOR) ¼ 1.43, 95% CI: 1.02 – 2.00] and WWH (aOR ¼ 1.36, 95% CI: 1.08 – 1.71); however, high-risk FRS was not (seronegative: aOR ¼ 1.03, 95% CI: 0.30 – 3.49; WWH: aOR ¼ 0.86, 95% CI: 0.23 – 3.20). Conclusion: Higher CVD risk was associated with increased frailty regardless of HIV serostatus among men and women. These findings may inform clinical practices of screening for frailty.

Original language	English (US)
Pages (from-to)	237-347
Number of pages	111
Journal	AIDS
Volume	36
Issue number	2
DOIs	https://doi.org/10.1097/QAD.0000000000003107
State	Published - Feb 1 2022

Funding

Sources of support: the contents of this publication are solely the responsibility of the authors and do not represent the official views of the National Institutes of Health (NIH). MWCCS (Principal Investigators): Atlanta CRS (Ighovwerha Ofotokun, Anandi Sheth, and Gina Wingood), U01-HL146241; Baltimore CRS (Todd Brown and Joseph Margolick), U01-HL146201; Bronx CRS (Kathryn Anastos and Anjali Sharma), U01-HL146204; Brooklyn CRS (Deborah Gustafson and Tracey Wilson), U01-HL146202; Data Analysis and Coordination Center (Gypsyamber D’Souza, Stephen Gange and Elizabeth Golub), U01-HL146193; Chicago-Cook County CRS (Mardge Cohen and Audrey French), U01-HL146245; Chicago-Northwestern CRS (Steven Wolinsky), U01-HL146240; Northern California CRS (Bradley Aouizerat, Jennifer Price, and Phyllis Tien), U01-HL146242; Los Angeles CRS (Roger Detels and Matthew Mimiaga), U01-HL146333; Metropolitan Washington CRS (Seble Kassaye and Daniel Merenstein), U01-HL146205; Miami CRS (Maria Alcaide, Margaret Fischl, and Deborah Jones), U01-HL146203; Pittsburgh CRS (Jeremy Martinson and Charles Rinaldo), U01-HL146208; UAB-MS CRS (Mirjam-Colette Kempf, Jodie Dionne-Odom, and Deborah Konkle-Parker), U01-HL146192; UNC CRS (Adaora Adimora), U01-HL146194. The MWCCS is funded primarily by the National Heart, Lung, and Blood Institute (NHLBI), with additional co-funding from the Eunice Kennedy Shriver National Institute Of Child Health & Human Development (NICHD), National Institute On Aging (NIA), National Institute Of Dental & Craniofacial Research (NIDCR), National Institute Of Allergy And Infectious Diseases (NIAID), National Institute Of Neurological Disorders And Stroke (NINDS), National Institute Of Mental Health (NIMH), National Institute On Drug Abuse (NIDA), National Institute Of Nursing Research (NINR), National Cancer Institute (NCI), National Institute on Alcohol Abuse and Alcoholism (NIAAA), National Institute on Deafness and Other Communication Disorders (NIDCD), National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), National Institute on Minority Health and Health Disparities (NIMHD), and in coordination and alignment with the research priorities of the National Institutes of Health, Office of AIDS Research (OAR). MWCCS data collection is also supported by UL1-TR000004 (UCSF CTSA), UL1-TR003098 (JHU ICTR), UL1-TR001881 (UCLA CTSI), P30-AI-050409 (Atlanta CFAR), P30-AI-073961 (Miami CFAR), P30-AI-050410 (UNC CFAR), P30-AI-027767 (UAB CFAR), and P30-MH-116867 (Miami CHARM). Sources of support: the contents of this publication are solely the responsibility of the authors and do not represent the official views of the National Institutes of Health (NIH). MWCCS (Principal Investigators): Atlanta CRS (Ighovwerha Ofotokun, Anandi Sheth, and Gina Wingood), U01-HL146241; Baltimore CRS (Todd Brown and Joseph Margolick), U01-HL146201; Bronx CRS (Kathryn Anastos and Anjali Sharma), U01-HL146204; Brooklyn CRS (Deborah Gustafson and Tracey Wilson), U01-HL146202; Data Analysis and Coordination Center (Gypsyamber D'Souza, Stephen Gange and Elizabeth Golub), U01-HL146193; Chicago-Cook County CRS (Mardge Cohen and Audrey French), U01-HL146245; Chicago-Northwestern CRS (Steven Wolinsky), U01-HL146240; Northern California CRS (Bradley Aouizerat, Jennifer Price, and Phyllis Tien), U01-HL146242; Los Angeles CRS (Roger Detels and Matthew Mimiaga), U01-HL146333; Metropolitan Washington CRS (Seble Kassaye and Daniel Merenstein), U01-HL146205; Miami CRS (Maria Alcaide, Margaret Fischl, and Deborah Jones), U01-HL146203; Pittsburgh CRS (Jeremy Martinson and Charles Rinaldo), U01-HL146208; UAB-MS CRS (Mirjam-Colette Kempf, Jodie Dionne-Odom, and Deborah Konkle-Parker), U01-HL146192; UNC CRS (Adaora Adimora), U01-HL146194. The MWCCS is funded primarily by the National Heart, Lung, and Blood Institute (NHLBI), with additional co-funding from the Eunice Kennedy Shriver National Institute Of Child Health & Human Development (NICHD), National Institute On Aging (NIA), National Institute Of Dental & Craniofacial Research (NIDCR), National Institute Of Allergy And Infectious Diseases (NIAID), National Institute Of Neurological Disorders And Stroke (NINDS), National Institute Of Mental Health (NIMH), National Institute On Drug Abuse (NIDA), National Institute Of Nursing Research (NINR), National Cancer Institute (NCI), National Institute on Alcohol Abuse and Alcoholism (NIAAA), National Institute on Deafness and Other Communication Disorders (NIDCD), National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), National Institute on Minority Health and Health Disparities (NIMHD), and in coordination and alignment with the research priorities of the National Institutes of Health, Office of AIDS Research (OAR). MWCCS data collection is also supported by UL1-TR000004 (UCSF CTSA), UL1-TR003098 (JHU ICTR), UL1-TR001881 (UCLA CTSI), P30-AI-050409 (Atlanta CFAR), P30-AI-073961 (Miami CFAR), P30-AI-050410 (UNC CFAR), P30-AI-027767 (UAB CFAR), and P30-MH-116867 (Miami CHARM). M.H.K. reports consulting for Sanofi. P.C.T. received grant support from Merck. A.S. received grant support from Gilead Sciences. F.J.P. has received support from Gilead Sciences, Janssen, ViiV, and Merck. A.A.Ad. has received personal funds from Merck and Gilead; Merck and Gilead have also provided her institution with funding for her research. All other authors declare no conflicts.

Keywords

Cardiovascular risk
Cohort
Frailty
HIV
Men
Women

ASJC Scopus subject areas

Immunology and Allergy
Immunology
Infectious Diseases

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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10.1097/QAD.0000000000003107

Cite this

Kuniholm, M. H., Vasquez, E., Appleton, A. A., Kingsley, L., Palella, F. J., Budoff, M., Michos, E. D., Fox, E., Jones, D., Adimora, A. A., Ofotokun, I., D’souza, G., Weber, K. M., Tien, P. C., Plankey, M., Sharma, A., & Gustafson, D. R. (2022). Cardiovascular risk score associations with frailty in men and women with or at risk for HIV. AIDS, 36(2), 237-347. https://doi.org/10.1097/QAD.0000000000003107

@article{a63a5bb58e3049cd9ee661e2e68288b9,

title = "Cardiovascular risk score associations with frailty in men and women with or at risk for HIV",

abstract = "Objective: To understand the relationship between cardiovascular disease (CVD) risk and frailty among men (MWH) and women living with HIV (WWH), or at risk for HIV. Design: We considered 10-year coronary heart disease and atherosclerotic CVD risk by Framingham risk score (FRS, 2001 National Cholesterol Education Program Adult Treatment Program III) and Pooled Cohort Equations (PCE, 2013 American College of Cardiology/American Heart Association) in relation to the Fried Frailty Phenotype (FFP) in the Multicenter AIDS Cohort Study (MACS) and Women{\textquoteright}s Interagency HIV Study (WIHS). Methods: FFP was ascertained in MACS from 2004 to 2019 and in WIHS from 2005 to 2006 and 2011 – 2019. FFP score at least three of five components defined frailty. Repeated measures logistic regression (both cohorts) and Cox proportional hazards regression (MACS) were performed, controlled for education, income, cholesterol medication and hepatitis C virus serostatus, and among MWH and WWH, CD4{\th} cell count/ml, antiretroviral therapy, and HIV viral load. Results: There were 5554 participants (1265 HIV seronegative/1396 MWH; 768 seronegative/1924 WWH) included. Among men, high-risk FRS was associated with increased risk of incident frailty among seronegative [adjusted hazard ratio (aHR)) ¼ 2.12, 95% confidence interval (CI):1.22 – 3.69] and MWH (aHR ¼ 2.19, 95% CI: 1.33 – 3.61). Similar associations were seen with high-risk PCE and incident frailty among SN (aHR ¼ 1.88, 95% CI: 1.48 – 2.39) and MWH (aHR ¼ 1.59, 95% CI: 1.26 – 2.00). Among women, high-risk PCE was associated with frailty in SN [adjusted odds ratio (aOR) ¼ 1.43, 95% CI: 1.02 – 2.00] and WWH (aOR ¼ 1.36, 95% CI: 1.08 – 1.71); however, high-risk FRS was not (seronegative: aOR ¼ 1.03, 95% CI: 0.30 – 3.49; WWH: aOR ¼ 0.86, 95% CI: 0.23 – 3.20). Conclusion: Higher CVD risk was associated with increased frailty regardless of HIV serostatus among men and women. These findings may inform clinical practices of screening for frailty.",

keywords = "Cardiovascular risk, Cohort, Frailty, HIV, Men, Women",

author = "Kuniholm, {Mark H.} and Elizabeth Vasquez and Appleton, {Allison A.} and Lawrence Kingsley and Palella, {Frank J.} and Matthew Budoff and Michos, {Erin D.} and Ervin Fox and Deborah Jones and Adimora, {Adaora A.} and Igho Ofotokun and Gypsyamber D{\textquoteright}souza and Weber, {Kathleen M.} and Tien, {Phyllis C.} and Michael Plankey and Anjali Sharma and Gustafson, {Deborah R.}",

year = "2022",

month = feb,

day = "1",

doi = "10.1097/QAD.0000000000003107",

language = "English (US)",

volume = "36",

pages = "237--347",

journal = "AIDS",

issn = "0269-9370",

publisher = "Lippincott Williams and Wilkins",

number = "2",

}

Kuniholm, MH, Vasquez, E, Appleton, AA, Kingsley, L, Palella, FJ, Budoff, M, Michos, ED, Fox, E, Jones, D, Adimora, AA, Ofotokun, I, D’souza, G, Weber, KM, Tien, PC, Plankey, M, Sharma, A & Gustafson, DR 2022, 'Cardiovascular risk score associations with frailty in men and women with or at risk for HIV', AIDS, vol. 36, no. 2, pp. 237-347. https://doi.org/10.1097/QAD.0000000000003107

TY - JOUR

T1 - Cardiovascular risk score associations with frailty in men and women with or at risk for HIV

AU - Kuniholm, Mark H.

AU - Vasquez, Elizabeth

AU - Appleton, Allison A.

AU - Kingsley, Lawrence

AU - Palella, Frank J.

AU - Budoff, Matthew

AU - Michos, Erin D.

AU - Fox, Ervin

AU - Jones, Deborah

AU - Adimora, Adaora A.

AU - Ofotokun, Igho

AU - D’souza, Gypsyamber

AU - Weber, Kathleen M.

AU - Tien, Phyllis C.

AU - Plankey, Michael

AU - Sharma, Anjali

AU - Gustafson, Deborah R.

PY - 2022/2/1

Y1 - 2022/2/1

N2 - Objective: To understand the relationship between cardiovascular disease (CVD) risk and frailty among men (MWH) and women living with HIV (WWH), or at risk for HIV. Design: We considered 10-year coronary heart disease and atherosclerotic CVD risk by Framingham risk score (FRS, 2001 National Cholesterol Education Program Adult Treatment Program III) and Pooled Cohort Equations (PCE, 2013 American College of Cardiology/American Heart Association) in relation to the Fried Frailty Phenotype (FFP) in the Multicenter AIDS Cohort Study (MACS) and Women’s Interagency HIV Study (WIHS). Methods: FFP was ascertained in MACS from 2004 to 2019 and in WIHS from 2005 to 2006 and 2011 – 2019. FFP score at least three of five components defined frailty. Repeated measures logistic regression (both cohorts) and Cox proportional hazards regression (MACS) were performed, controlled for education, income, cholesterol medication and hepatitis C virus serostatus, and among MWH and WWH, CD4þ cell count/ml, antiretroviral therapy, and HIV viral load. Results: There were 5554 participants (1265 HIV seronegative/1396 MWH; 768 seronegative/1924 WWH) included. Among men, high-risk FRS was associated with increased risk of incident frailty among seronegative [adjusted hazard ratio (aHR)) ¼ 2.12, 95% confidence interval (CI):1.22 – 3.69] and MWH (aHR ¼ 2.19, 95% CI: 1.33 – 3.61). Similar associations were seen with high-risk PCE and incident frailty among SN (aHR ¼ 1.88, 95% CI: 1.48 – 2.39) and MWH (aHR ¼ 1.59, 95% CI: 1.26 – 2.00). Among women, high-risk PCE was associated with frailty in SN [adjusted odds ratio (aOR) ¼ 1.43, 95% CI: 1.02 – 2.00] and WWH (aOR ¼ 1.36, 95% CI: 1.08 – 1.71); however, high-risk FRS was not (seronegative: aOR ¼ 1.03, 95% CI: 0.30 – 3.49; WWH: aOR ¼ 0.86, 95% CI: 0.23 – 3.20). Conclusion: Higher CVD risk was associated with increased frailty regardless of HIV serostatus among men and women. These findings may inform clinical practices of screening for frailty.

AB - Objective: To understand the relationship between cardiovascular disease (CVD) risk and frailty among men (MWH) and women living with HIV (WWH), or at risk for HIV. Design: We considered 10-year coronary heart disease and atherosclerotic CVD risk by Framingham risk score (FRS, 2001 National Cholesterol Education Program Adult Treatment Program III) and Pooled Cohort Equations (PCE, 2013 American College of Cardiology/American Heart Association) in relation to the Fried Frailty Phenotype (FFP) in the Multicenter AIDS Cohort Study (MACS) and Women’s Interagency HIV Study (WIHS). Methods: FFP was ascertained in MACS from 2004 to 2019 and in WIHS from 2005 to 2006 and 2011 – 2019. FFP score at least three of five components defined frailty. Repeated measures logistic regression (both cohorts) and Cox proportional hazards regression (MACS) were performed, controlled for education, income, cholesterol medication and hepatitis C virus serostatus, and among MWH and WWH, CD4þ cell count/ml, antiretroviral therapy, and HIV viral load. Results: There were 5554 participants (1265 HIV seronegative/1396 MWH; 768 seronegative/1924 WWH) included. Among men, high-risk FRS was associated with increased risk of incident frailty among seronegative [adjusted hazard ratio (aHR)) ¼ 2.12, 95% confidence interval (CI):1.22 – 3.69] and MWH (aHR ¼ 2.19, 95% CI: 1.33 – 3.61). Similar associations were seen with high-risk PCE and incident frailty among SN (aHR ¼ 1.88, 95% CI: 1.48 – 2.39) and MWH (aHR ¼ 1.59, 95% CI: 1.26 – 2.00). Among women, high-risk PCE was associated with frailty in SN [adjusted odds ratio (aOR) ¼ 1.43, 95% CI: 1.02 – 2.00] and WWH (aOR ¼ 1.36, 95% CI: 1.08 – 1.71); however, high-risk FRS was not (seronegative: aOR ¼ 1.03, 95% CI: 0.30 – 3.49; WWH: aOR ¼ 0.86, 95% CI: 0.23 – 3.20). Conclusion: Higher CVD risk was associated with increased frailty regardless of HIV serostatus among men and women. These findings may inform clinical practices of screening for frailty.

KW - Cardiovascular risk

KW - Cohort

KW - Frailty

KW - HIV

KW - Men

KW - Women

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DO - 10.1097/QAD.0000000000003107

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VL - 36

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JO - AIDS

JF - AIDS

IS - 2

ER -

Cardiovascular risk score associations with frailty in men and women with or at risk for HIV

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UN SDGs

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