REPRIEVE Analysis of New Cardiovascular Risk Calculators in HIV: Underpredicting Risk Means Preventing Fewer Heart Attacks

Imagine if we could perfectly predict who would have an atherosclerotic cardiovascular disease (ASCVD) event.Even better if we could discern whose heart attack a statin would have prevented.Without a crystal ball, we rely on clinical risk prediction tools.The best tools are easy to use, discriminate well between those with and without future events, and are well-calibrated (predicted equals observed risk across risk strata and subgroups).Imperfect tools need improvement and updating.New equations called Predicting Risk of Cardiovascular Disease Events (PREVENT) were recently developed to replace the American Heart Association/American College of Cardiology's Pooled Cohort Equations (PCE).[1]The PCE overestimate risk in the general population, so PREVENT were designed to predict lower risk (Figure).PREVENT are better calibrated than the PCE in the general population.[2,3] Similarly, Systematic Coronary Risk Evaluation (SCORE) was recently updated in Europe to SCORE2.[4] ASCVD is a major threat to the health of people with HIV (PWH) even with effective HIV treatment, and risk is 1.5 to 2 times higher than the general population.[5][6][7] In contrast to the ------