Statin Use With the ATP III Guidelines Compared to the 2013 ACC/AHA Guidelines in HIV Primary Care Patients

Area of Science:

• Cardiology
• Infectious Diseases
• Pharmacology

Background:

• The 2013 Cholesterol Guidelines introduced a new atherosclerotic cardiovascular disease (ASCVD) risk calculator.
• Previous risk calculators, like the Framingham risk score (FRS), have shown limited applicability in patients with Human Immunodeficiency Virus (HIV).
• This study addresses the need to compare ASCVD and FRS applicability for statin initiation in HIV patients.

Purpose of the Study:

• To compare the 2013 ASCVD risk calculator and the Framingham risk score (FRS) for initiating statin therapy in patients with HIV.
• To evaluate the agreement between these two risk assessment tools in an HIV-positive population.
• To identify potential discrepancies in statin intensity recommendations for HIV patients.

Main Methods:

• Retrospective chart review of 155 HIV patients on statin therapy between October 1, 2013, and April 1, 2014.
• Data collected included demographics, laboratory results, and medication lists.
• Primary endpoint: assessment of agreement between the 2013 ASCVD guidelines and FRS for statin initiation and intensity.

Main Results:

• A moderate level of agreement (P < .001) was observed between the 2013 ASCVD guidelines and FRS in 116 out of 155 patients.
• Using the 2013 guidelines, 48 out of 86 patients requiring statins received the correct intensity.
• A majority of patients in the study population required statin therapy, irrespective of the guideline used.

Conclusions:

• There is a moderate agreement between the 2013 ASCVD guidelines and FRS for statin use in HIV patients.
• When considering drug interactions with antiretrovirals, 44.2% of HIV patients were prescribed incorrect statin intensity based on the 2013 guidelines.
• The findings suggest a need for careful consideration of guideline applicability and potential drug interactions when managing cardiovascular risk in HIV patients.