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Published on: October 12, 2017
Distance from low-density lipoprotein cholesterol targets across cardiovascular risk strata in people living with
Giuseppe Vittorio De Socio1, Anna Gidari1, Elena Delfina Ricci2
1Clinic of Infectious Diseases, Department of Medicine and Surgery, University of Perugia, Santa Maria Hospital, Perugia, Italy.
Insights
Lipid burden remains high in people living with HIV (PLWH), with significant LDL-cholesterol (LDL-C) excess across all risk groups. This highlights a critical gap in lipid-lowering therapy, especially for high-risk individuals.
Area of Science:
- Cardiovascular Health
- HIV Medicine
- Lipid Metabolism
Background:
- Previous studies used binary measures to assess statin use in people living with HIV (PLWH), failing to capture residual lipid burden.
- A significant gap exists between statin indication and prescription in PLWH.
Purpose of the Study:
- To quantify lipid burden in PLWH by measuring LDL-cholesterol (LDL-C) excess.
- To analyze LDL-C excess across different cardiovascular risk categories in PLWH.
Main Methods:
- A multicentre, nationwide, prospective cohort study analyzed data from 2,190 PLWH (2015-2025).
- Cardiovascular risk was assessed using SCORE2; LDL-C targets followed European AIDS Clinical Society guidelines.
- LDL-C excess was calculated as the difference between observed and target LDL-C levels.
Main Results:
- Statin prescription increased from 12.5% to 25.4%, while indication rose to ~80%.
- Only 9.7% of visits met LDL-C targets.
- Mean LDL-C excess was 18 mg/dL (low-risk), 40 mg/dL (intermediate-risk), and 51 mg/dL (high-risk).
- Substantial LDL-C excess persisted even in statin-treated PLWH.
Conclusions:
- LDL-C excess reveals a significant gap between lipid management guidelines and clinical practice in PLWH.
- Urgent, systematic lipid-lowering strategies are needed, particularly for intermediate- and high-risk PLWH in the post-REPRIEVE era.
Introduction:
Previous studies have described the gap between statin indication and prescription among people living with HIV (PLWH) using binary measures, which fail to capture the magnitude of residual lipid burden.
Objectives:
To quantify lipid burden in PLWH by measuring the distance from recommended LDL-cholesterol (LDL-C) targets ("LDL-C excess") across cardiovascular risk categories.
Design:
Multicentre, nationwide, prospective cohort study.
Methods:
We analysed data from 2,190 PLWH enrolled in the SCOLTA cohorts between 2015 and 2025, contributing 13,512 clinical observations (visits). Cardiovascular risk was assessed using SCORE2. LDL-C targets were defined according to the minimum thresholds recommended by historical European AIDS Clinical Society guidelines. LDL-C excess was calculated as the difference between observed LDL-C and the corresponding target and summarised as mean values with 95% confidence intervals (CI).
Results:
The proportion of visits meeting statin therapy criteria increased from 64.6% in 2015 to approximately 80% after 2021, whereas statin prescription rose only from 12.5% to 25.4%. LDL-C targets were achieved in 9.7% of visits. Mean LDL-C excess was 18 mg/dL in low-risk, 40 mg/dL in the intermediate, and 51 mg/dL in high-risk individuals. The excess was lower but remained substantial even among statin-treated PLWH.
Conclusions:
LDL-C excess highlights a clinically meaningful gap between guidelines and practice, particularly among intermediate- and high-risk PLWH, underscoring the urgent need for systematic lipid-lowering in the post-REPRIEVE era.
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