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Many people living with HIV at high risk of cardiovascular disease are not on statins
Michael Carter, 2017-07-19 11:10:00
Only half of
HIV-positive patients at a Chicago clinic eligible for statin therapy according to the latest US
guidelines are receiving this treatment, investigators report in the online
edition of the Journal of Acquired Immune
Deficiency Syndromes. The researchers say their findings raise concerns about sub-optimal cardiovascular disease prevention among people living with HIV.
The study also found that only a third of patients potentially
eligible for use of statins as preventative treatment, as distinct from treatment of diagnosed cardiovascular disease, were receiving statin therapy. More
reassuringly, the majority of patients with clinical CVD and/or diabetes were
“Less than half of
those for whom statins are recommended by 2013…guidelines were prescribed
statins,” comment the authors. “Though we acknowledge that current
cardiovascular guidelines have not been validated for the HIV+ population, this
study highlights potentially suboptimal CVD [cardiovascular disease] prevention
and management among HIV+ patients.”
People living with HIV
have an increased risk of cardiovascular disease, even when their viral load is
undetectable. Despite this, HIV is not
mentioned as a consideration in the 2013 edition of the American College of
Cardiology/American Heart Association (ACC/AHA) guidelines for assessing
cardiovascular disease risk and use of lipid-lowering medications to prevent
atherosclerotic cardiovascular disease (ASCVD) risk.
The US guidelines identified four groups of people who would benefit from statins: people with clinical cardiovascular disease, people with LDL cholesterol of 190 mg/dL or above (>4.9mmol/L), people with type 1 or 2 diabetes, or people aged 40-75 with an estimated cardiovascvular disease risk of 7.5% or above. (European AIDS Clinical Society 2016 guidelines recommend preventative statin treatment if the lifetime risk of cardiovascular disease reaches 10% or above).
There are limited
data on statin use by patients with HIV at risk of cardiovascular disease.
Investigators from the Infectious Diseases Center at Northwestern University
therefore designed a retrospective study analysing the prescription of statins
at their clinic to HIV-positive patients who would qualify for this therapy
according to ACC/AHA 2013 guidelines.
population consisted of 460 patients. Most (81%) were male and the median age
was 52 years.
Risk factors for
statin use were the presence of existing cardiovascular disease (coronary heart disease, peripheral arterial disease or prior stroke) or, age, race, gender, cholesterol, blood
pressure, hypertension, diabetes mellitus and smoking.
On the basis of
the 2013 ACC/AHA guidelines, 194 patients were eligible for statins. However,
only 95 of these individuals (49%) were prescribed this treatment.
Patients were more
likely to be prescribed statins if they had clinical ASCVD (OR = 46.5; 95% CI, 14-154, p < 0.0001) or diabetes mellitus (OR = 6.2; 95% CI, 3.4-11.4, p
< 0.0001). Statins were prescribed to 93% of patients with ASCVD, 56% of
patients with diabetes mellitus and 93% of individuals with both conditions.
with a ten-year risk score for CVD above 7.5% but no clinical disease were not significantly more likely
to be prescribed statins, and only 29% of patients eligible for statins for CVD
prevention were on this treatment.
were more likely than black patients to be on statins (p = 0.015) but there
was no significant gender difference (p = 0.059). Nor did viral load have a
significant effect on the likelihood of being on statins.
evidence strongly supports statin use in HIV+ patients,” write the
investigators. “HIV+ persons are exceptionally vulnerable to ASCVD compared to
the general population due to an increased burden of high-risk, non-calcified
plaque and higher prevalence of ASCVD risk factors.”
that the 2013 ACC/AHA guidelines combined with an assessment of ten-year CVD
risk should be used to determine which HIV-positive patients should be offered
evidence of increased CVD risk in HIV+ patients, likely even higher than
predicted by the ACC/AHA guidelines, underscores the need for corrective
measures,” conclude the researchers. “Further studies are needed to evaluate 2013
ACC/AHA guidelines uptake in broader HIV+ patient populations, and strategies
are needed to optimize compliance and best practice for cardiovascular health
in HIV+ patients.”