ABC | Volume 114, Nº1, January 2019

Original Article Silva et al. Risk stratification with reduced DAD Score Arq Bras Cardiol. 2020; 114(1):68-75 Figure 1 – Cardiovascular risk factors in 71 HIV-positive patients. Obesity Sedentarism Age CAD HF Diabetes mellitus Dyslipidemia Hypertension Smoking 0,0 10,0 20,0 30,0 40,0 % 50,0 60,0 70,0 80,0 15.5 64.8 42.3 9.9 18.3 74.6 25.3 22.5 Figure 2 – Cardiovascular risk rating in 71 HIV-positive patients according to Framingham 2008 and reduced DAD scores. 100.00 90.00 80.00 70.00 60.00 50.00 40.00 30.00 20.00 10.00 0.00 63.4 11.3 25.3 23.9 54.9 21.2 High/very high Intermediate Low Framingham 2008 Reduced DAD the Framingham 2008 score and intermediate risk by the reduced DAD score, while the distribution of high risk was similar for both scores. Data from Nery et al. 14 showed most patients classified as low risk by both Framingham and DAD full scores (94% x 74.2%), respectively, and both scores had a much smaller number of patients classified as high risk (2.8% and 2.1%), respectively, than in our sample. 14 Although these scores are not used to estimate the presence of subclinical atherosclerosis, data from Jericó et al. 16 show an increasing prevalence of subclinical carotid atherosclerosis according to cardiovascular risk category, with 26.6%, 35.3% and 76,5% for very low risk, low risk and moderate/high risk patients, respectively. 16 Similar results were found in this study, where a positive correlation between medium-intimal thickening and score value was reported. These data are important and suggest that many patients classified as low and intermediate risk could be reclassified and managed as high risk due to the presence of subclinical atherosclerosis. According to a recent publication, the Framingham’s score could underestimate cardiovascular risk in HIV-positive patients by showing a high prevalence of subclinical carotid atherosclerosis in patients sorted as low risk. 8 The same authors suggest that the use of DAD full score allows a better association between risk stratification and the presence of subclinical atherosclerosis, and that other tools such as the verification of medium-intimal thickening may bring new information that can reclassify patients and reinforce the taking of measures of greater impact to control cardiovascular risk factors. 71