Statins lower atherosclerotic cardiovascular disease (ASCVD) risk in the general population, and people with HIV have higher rates of ASCVD. But previous research found low statin use in HIV-positive people, at least according to older (Adult Treatment Panel III) guidelines.
To determine whether statin prescription practices in an HIV clinic population reflect updated 2013 guidelines from the American College of Cardiology (ACC) and American Heart Association (AHA), researchers at Washington University in St. Louis conducted a study, the results of which were presented at IDWeek.
The analysis involved 1,085 HIV-positive people at least 40 years old who visited the clinic during 2015.
The research team classified participants into four statin benefit groups as specified in ACC/AHA guidelines: (1) clinical ASCVD; (2) primary hyperlipidemia (LDL-C ≥ 190 mg/dL); (3) 40 to 75 years old with diabetes and LDL-C 70 to 189 mg/dL without ASCVD; or (4) 40 to 75 years old without ASCVD or diabetes, with LDL-C 70 to 189 mg/dL, and with a 10-year ASCVD risk of ≥ 7.5%.
The study group averaged 51.9 years in age; 71% of participants were men, 68% were black, and 98% were on antiretroviral therapy, with 86% having an undetectable viral load.
Researchers found that among 1,085 participants, 450 (41%) had a statin indication by ACC/AHA criteria. However, only 161 of those 450 people (36%) had a statin prescription, including 36% in group 1, 44% in group 2, 49% in group 3, and 29% in group 4.
Among participants with a statin prescription, the proportion of people prescribed high-dose statins were 30% in group 1, 75% in group 2, 29% in group 3, and 21% in group 4.
Compared with patients not prescribed statins, those prescribed a statin had a higher median CD4 count (630 versus 573 cells/mm3, P = 0.050) and a marginally higher rate of viral suppression (93% versus 88%, P = 0.073). In indication group 4, a significantly higher proportion of people with a statin prescription had viral suppression (95% versus 87%, P = 0.031).
Statin users did not differ significantly from nonusers in the following: proportion of people taking five or more antiretrovirals; median number of total medications; or proportion of people taking an HIV agent that may interact with statins (namely ritonavir [Norvir], cobicistat, or efavirenz [Sustiva]).
The researchers conclude that "two thirds of our patients were not prescribed statins despite a strong indication ... based on the new [ACC/AHA] guidelines." The investigators surmised that HIV providers may not routinely consult ACC/AHA guidelines.