Relationship Between Cardiovascular Risk Scores and Subclinical Coronary Artery Disease in People Living with HIV

Background People living with HIV (PLWH) have an increased risk of cardiovascular disease, and conventional risk scores may underestimate subclinical coronary atherosclerosis. Coronary computed tomography angiography (CCTA) enables direct plaque assessment and may improve cardiovascular risk stratification. This study evaluated factors associated with subclinical coronary disease and the performance of cardiovascular risk scores in high-risk PLWH. Methods A prospective, single-center observational study was conducted including 83 PLWH aged ≥ 40 years with sustained virological suppression between March 2022 and March 2023. Cardiovascular risk was estimated using Framingham, SCORE2, REGICOR, and D:A:D scores. Participants classified as high or very high risk underwent CCTA to detect subclinical coronary atherosclerosis. Clinical and laboratory variables associated with coronary disease were analyzed, and the predictive performance of risk scores was assessed using receiver operating characteristic (ROC) curves. Results The mean age was 59 years, and 92% of participants were male. Forty-seven individuals were classified as high cardiovascular risk. Subclinical coronary artery disease was detected in 52.2% of cases. Most lesions were mild and non-obstructive, although 48% of plaques showed vulnerability features. Fasting glucose levels were significantly associated with subclinical coronary disease (ρ = 0.47; p = 0.02). Among risk scores, the Framingham score demonstrated the highest predictive performance for CAC ≥ 100 (AUC = 0.78), followed by the reduced D:A:D score (AUC = 0.77) Conclusions High-risk PLWH exhibit a high prevalence of subclinical coronary atherosclerosis. Fasting glucose was the main associated factor. Conventional cardiovascular risk scores showed moderate predictive ability, with the Framingham score performing best.