Impact of Cardiovascular Risk on Mortality Among People Living With Hiv: Real-World Data From a Reference Center in Salvador, Bahia

The risk of cardiovascular disease is elevated among people living with HIV (PLHIV), particularly the occurrence of coronary artery disease and stroke. This study aimed to assess mortality and cardiovascular events among PLHIV followed at the Reference Center in Salvador, Bahia. This retrospective cohort included PLHIV aged ≥ 18 years who underwent cardiovascular risk assessment using the Framingham Score (FS) in 2012. Outcomes of interest were stroke, angina, acute myocardial infarction (AMI), thrombosis, and death occurring up to December 31, 2023. Participants were stratified as FS ≥ 10% (moderate/high risk, Group 1) and FS < 10% (low risk, Group 2). Clinical, sociodemographic, and laboratory data were extracted from medical records and analyzed in R Studio. Descriptive and inferential statistics were applied (Pearson’s chi-square test, relative risk RR, and Kaplan-Meier survival analysis). The study was approved by the SESAB Research Ethics Committee. A total of 440 individuals were included, mean age 42.3 (± 10.1) years, 52.0% male. At baseline, 15.0% were hypertensive, 12.5% had dyslipidemia, 7.5% had diabetes mellitus, and 17.3% reported smoking. Mean follow-up duration was 2,620 days. At follow-up, 112 events occurred: 2.7% stroke, 1.8% AMI, 1.4% angina, 0.5% thrombosis, and 18.75% all-cause deaths. Group 1 comprised 31 (7.0%) individuals (FS ≥ 10%), among whom 7 (22.6%) experienced cardiovascular events and 8 (25.8%) died. In Group 2 (low risk), mortality was 18.6%, and 5.1% experienced events. The risk of events or death in Group 1 was twice as high (RR 2.0; 95% CI: 1.4–3.1; p < 0.01) compared with Group 2. For events alone, risk was 4.4 times higher (RR 4.4; 95% CI: 2.1–9.5; p < 0.01). High mortality and elevated incidence of cardiovascular events were found in this population. The Framingham Score proved useful but underestimated the identification of individuals most prone to events. Results highlight the importance of monitoring and managing cardiovascular risk factors in PLHIV and underscore the need for complementary risk-assessment tools for this population.