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Patients Living With HIV Are Less Likely to Receive Appropriate Statin Therapy for Cardiovascular Disease Risk
Roshni P Emmons1, Nicholas V Hastain2, Todd A Miano3
1Department of Pharmacy Practice, Jefferson College of Pharmacy, Philadelphia, PA, USA.
Insights
Patients with HIV are less likely to receive appropriate statin therapy for atherosclerotic cardiovascular disease (ASCVD) risk reduction compared to those without HIV. This highlights a gap in care for statin-eligible individuals living with HIV.
Area of Science:
- Cardiology
- Infectious Diseases
- Pharmacology
Background:
- Patients living with HIV (PLWH) face increased risk of atherosclerotic cardiovascular disease (ASCVD).
- Studies indicate statins may be underprescribed in PLWH at risk for ASCVD.
- Previous research has not compared appropriate statin intensity between eligible PLWH and uninfected individuals.
Purpose of the Study:
- To determine if statin-eligible PLWH receive appropriate statin therapy less often than patients without HIV.
- To identify disparities in statin prescribing for ASCVD risk reduction in PLWH.
Main Methods:
- Retrospective study of statin eligibility and prescribing from June-September 2018.
- Utilized American College of Cardiology/American Heart Association cholesterol guidelines.
- Compared statin treatment appropriateness between HIV-infected and uninfected patient groups using chi-square and logistic regression.
Main Results:
- 221 out of 300 subjects were eligible for statin therapy.
- Only 30.2% of eligible PLWH received appropriate statin intensity versus 67.0% of controls (p < 0.001).
- PLWH were significantly less likely to receive appropriate statin therapy; polypharmacy was associated with appropriate therapy.
Conclusions:
- PLWH are at a disadvantage in receiving appropriate statin therapy for ASCVD risk reduction.
- This care gap is critical given the elevated ASCVD risk in PLWH.
- Strategies to improve statin prescribing for ASCVD prevention in PLWH are needed.
Background:
Recent studies suggest that statins are underprescribed in patients living with HIV (PLWH) at risk for atherosclerotic cardiovascular disease (ASCVD), but none have assessed if eligible patients receive the correct statin and intensity compared to uninfected controls.
Objectives:
The primary objective was to determine whether statin-eligible PLWH are less likely to receive appropriate statin therapy compared to patients without HIV.
Methods:
This retrospective study evaluated statin eligibility and prescribing among patients in both an HIV and internal medicine clinic at an urban, academic medical center from June-September 2018 using the American College of Cardiology/American Heart Association guideline on treating blood cholesterol to reduce ASCVD risk. Patients were assessed for eligibility and actual treatment with appropriate statin therapy. Characteristics of patients appropriately and not appropriately treated were compared with chi-square testing and predictors for receiving appropriate statin therapy were determined with logistic regression.
Results:
A total of 221/300 study subjects were statin-eligible. Fewer statin-eligible PLWH were receiving the correct statin intensity for their risk benefit group versus the uninfected control group (30.2% vs 67.0%, p < 0.001). In the multivariable logistic regression analysis, PLWH were significantly less likely to receive appropriate statin therapy, while those with polypharmacy were more likely to receive appropriate statin therapy.
Conclusion:
Our study reveals that PLWH may be at a disadvantage in receiving appropriate statin therapy for ASCVD risk reduction. This is important given the heightened risk for ASCVD in this population, and strategies that address this gap in care should be explored.
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