Improving Statin Prescribing Practices For Patients With HIV

Persons with HIV are at increased risk of atherosclerotic cardiovascular disease due to increased risk of HIV-associated inflammation and coagulation.

The majority of statin-eligible patients at one of the largest HIV clinics in New Orleans received a statin in accordance with 2013 American College of Cardiology/American Heart Association (ACC/AHA) guidelines on the treatment of blood cholesterol,1 according to research presented at the 2016 IDWeek meeting.2

Persons with HIV are at increased risk of atherosclerotic cardiovascular disease (ASCVD) compared to individuals who are HIV-negative. Causes posited for this increased risk include HIV-associated inflammation and coagulation, and the adverse effect profiles of certain highly active antiretroviral therapy (HAART) regimens.3-5

“We wanted to measure statin usage in HIV positive patients to determine how our clinic was managing this risk via the application of the ACC/AHA blood cholesterol guidelines,” said lead researcher Brittany Gorden, PharmD in an email interview with Infectious Disease Advisor.  Dr Gorden is a resident in pharmacy at Xavier University College of Pharmacy in New Orleans.

Using the Epic electronic health record database, Dr Gorden and colleagues conducted a retrospective chart review for 250 randomly selected HIV-positive patients aged 40 to 75 years who had visited the Infectious Diseases Center at University Medical Center New Orleans at least once between December 1, 2013 and September 30, 2015. Results showed that 127 patients were statin-eligible, and 59.8% (n=76) of those patients had received a statin prescription.

A secondary aim of the study was to determine the factors associated with statin receipt. Patient factors associated with greater statin prescribing were increasing age (odds ratio [OR]: 1.34; 95% confidence interval [CI],0.79-2.26) and female gender (OR: 1.66; 95% CI,0.75-3.67). A lack of subsidized insurance was also associated with decreased statin prescribing (OR: 0.96; 95% CI,0.74-1.24).

None of the patient factors investigated showed statistical significance. “This was most likely due to our loss of sample due to exclusion criteria,” commented Dr Gorden. “One question is if statistical significance [could] be shown with a larger initial sample. Also, we would like to look further at other patient and provider factors to determine if any correlation exists.”

Pooled Cohort 10-Year Risk Assessment equations, which estimate 10-year ASCVD risk (defined as first occurrence non-fatal and fatal myocardial infarction, and nonfatal and fatal stroke), were used to calculate risk for patients without a previous history of clinical ASCVD, diabetes, or a low-density lipoprotein cholesterol (LDL-C) ≥190 mg/dL Of the statin-eligible patients not receiving a statin, 82% required ASCVD risk calculation.

“Despite the majority of statin-eligible patients receiving a statin, the results from this study demonstrate an opportunity for improved patient care,” the researchers concluded. “The inclusion of an automatically calculated risk assessment may improve statin prescribing practices for HIV patients.”

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  1. Stone NJ, Robinson JG, Lichtenstein AH, et al. 2013 ACC/AHA guideline on the treatment of blood cholesterol to reduce atherosclerotic cardiovascular risk in adults: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol. 2014;63(25 Pt B):2889-2934. doi:10.1016/j.jacc.2013.11.002.
  2. Gorden B, Gordon L, Frontini M, et al. Application of the 2013 American College of Cardiology/American Heart Association blood cholesterol guidelines in HIV patients in an ambulatory care setting. Poster 2136. Presented at ID Week. October 29, 2016; New Orleans, LA. Accessed October 31, 2016.
  3. Barbaro G. Heart and HAART: Two sides of the coin for HIV-associated cardiology issues. World J Cardiol. 2010;2(3):53-57. doi:10.4330/wjc.v2.i3.53.
  4. Deeks SG. HIV infection, inflammation, immunosenescence, and aging. Annu Rev Med. 2011;62:141-155. doi:10.1146/annurev-med-042909-093756.
  5. Duprez DA, Neuhaus J, Kuller LH, et al. Inflammation, coagulation and cardiovascular disease in HIV-infected individuals. PloS One. 2012;7(9):e44454. doi:10.1371/journal.pone.0044454.

This article originally appeared on The Cardiology Advisor