Among people with a high risk of cardiovascular disease, established sets of guidelines for cholesterol management appear to recommend statins for HIV-positive people much less often than for HIV-negative people, researchers reported in Open Forum Infectious Diseases.
The study utilized data on 1,394 people living with HIV, 71 of whom had a CVD event, and 6,141 matched controls (among whom there were 197 CVD events). The more recent American College of Cardiology/American Heart Association (ACA/AHA) guidelines recommended statins for more people living with HIV who went on to have a CVD event (59%) than did the older National Cholesterol Education Program Adult Treatment Program III (ATPIII) guidelines (35%). The corresponding figures for HIV-negative controls were 72% and 43%, respectively.
Despite the higher statin recommendation rates seen with the ACA/AHA guidelines, the researchers found that many high-risk patients were missed: Data indicated that 40% of HIV-positive patients (compared to 29% of HIV-negative controls) who went on to experience a CVD event would not have met ACT/AHA guideline criteria. Further, a tendency to underprescribe statins was also observed in the study: Statins were prescribed to 22% of participants living with HIV who met guideline criteria, compared to 34% of controls.
Results show that even recently updated cholesterol guidelines do not adequately take into account the unique CVD risk factors associated with HIV, study authors said. "Our findings underscore an urgent need for ongoing research on CVD risk stratification and prevention strategies in HIV," they concluded.