Baseline 10-Year Cardiovascular Risk Scores Predict Cognitive Function in Older Persons, and Particularly Women, Living With Human Immunodeficiency Virus Infection

BACKGROUND: Cardiovascular disease (CVD) and associated comorbidities increase the risk of cognitive impairment in persons living with HIV (PLWH). Given the potential composite effect of multiple cardiovascular risk factors on cognition, we examined the ability of the Atherosclerotic Cardiovascular Disease (ASCVD) risk score and the Framingham Heart Study Global CVD risk score (FRS) to predict future cognitive function in older PLWH. METHODS: We constructed linear regression models evaluating the association between baseline 10-year CV risk scores and cognitive function (measured by NPZ-4 score) at a Year 4 follow up visit. RESULTS: Among 988 participants (mean age 52 years, 20% women), mean 10-year ASCVD risk score at entry into the cohort was 6.8% (SD 7.1%) and FRS was 13.1% (SD 10.7%). In models adjusted only for cognitive function at entry, the ASCVD risk score significantly predicted Year 4 NPZ-4 in the entire cohort and after stratification by sex (for every 1% higher ASCVD risk, Year 4 NPZ-4 was lower by 0.84 SD +/- 0.28 overall, p=0.003; lower by 2.17 SD +/- 0.67 in women, p=0.001; lower by 0.78 SD +/- 0.32 in men, p=0.016). A similar relationship was observed between FRS and Year 4 NPZ-4. In multivariable models, higher 10-year ASCVD risk and FRS predicted lower NPZ-4 in women. CONCLUSION: Baseline 10-year ASCVD risk and FRS predicted future cognitive function in older PLWH with well-controlled infection. CV risk scores may help to identify individuals, especially women, living with HIV who are at risk for worse cognition over time.