Cross-sectional Comparison of the PREVENT and Pooled Cohort Equations for 10-Year Atherosclerotic Cardiovascular Risk Estimates in a U.S. Cohort of Black and Latina Transgender Women with HIV

Background: Transgender women with HIV face higher rates of atherosclerotic cardiovascular disease (ASCVD) than the general population. However, ASCVD risk estimators use binary sex variables that may misclassify their risk. We examined the effects of sex variable inputs in the Predicting Risk of Cardiovascular Disease Events (PREVENT) and Pooled Cohort Equation (PCE) risk calculations and tested for associations of ASCVD risk scores with HIV and hormone use. Setting: Participants were recruited from health centers in Boston, New York, and Washington, DC. Methods: We performed a cross-sectional comparison of PCE and PREVENT scores by sex variable inputs using data from 108 Black and Latina transgender women with HIV. Logistic regression models tested whether hormone duration and time since HIV diagnosis were associated with hyperlipidemia, diabetes, hypertension, or cardiac events. Results: Using an illustrative ≥ 5% risk score as the threshold for statin initiation, 40.6% with PCE versus 9.5% with PREVENT met or exceeded 5% risk when male was entered for all, compared with 17.7% with PCE versus 9.5% with PREVENT when female was entered for all, and 24.0% with PCE versus 8.4% with PREVENT when female was entered for participants taking hormones. Neither years since HIV diagnosis nor hormone duration were associated with ASCVD risk factors or events Conclusion: Use of the PREVENT calculator generates lower ASCVD risk estimates than PCE in transgender women with HIV. Research is needed to determine how best to incorporate gender diversity and intersecting factors into ASCVD risk calculations.