Prognostic value of ankle‐brachial index and cardio‐ankle vascular index for mortality and cardiovascular events in older people with HIV on long‐term ART

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Abstract
Objectives: To assess the association of the Cardio‐Ankle Vascular Index (CAVI) and ankle‐brachial index (ABI) with all‐cause mortality and major adverse cardiovascular events (MACE) in older people with HIV receiving long‐term antiretroviral therapy (ART) in Thailand. Methods: We conducted a prospective cohort study of 307 virologically suppressed participants aged ≥50 years who underwent baseline CAVI and ABI measurements. ABI was analysed both as a continuous variable and as a categorical variable using a cut‐off p = 0.004) but did not reach statistical significance for the composite outcome (aHR 1.64, 95% CI: 0.89–3.01, p = 0.112). However, when modelled as a continuous variable, each unit increase in CAVI was associated with an increased risk of composite outcome (aHR 1.29, 95% CI: 1.08–1.54, p = 0.004). Ever smoking, hypertension and elevated IL‐6 were significantly associated with increased risk of mortality and MACE. ABI < 0.9 was strongly associated with mortality (aHR 4.20, 95% CI: 1.43–12.27). Conclusions: In older people with HIV on long‐term ART, traditional cardiovascular risk, systemic inflammation (IL‐6) and low ABI (<0.9) were stronger predictors of mortality and MACE. CAVI demonstrated prognostic value for mortality and the composite outcome, suggesting a potential complementary role in cardiovascular risk assessment. Clinical trial registration: HIVNAT 006 (NCT00411983).

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