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HIV-Infected Veterans and the New ACC/AHA Cholesterol Guidelines: Got Statins?
Meredith E. Clement1, Lawrence Park1, Ann Marie Navar-Boggan1, Nwora L. Okeke1, Michael Pencina1, Pamela Douglas1, Susanna Naggie1
1 Duke University, Durham, NC, United States.
Background: Cardiovascular disease, an HIV-associated non-AIDS related (HANA) condition, is an emerging threat to people living with HIV; thus, appropriate primary and secondary prevention is critical. In November 2013 updated guidelines for cholesterol treatment from the American College of Cardiology and the American Heart Association (ACC/AHA) substantially expanded recommendations for statin use among the general population for cardiovascular disease (CVD) prevention compared to the prior Adult Treatment Panel (ATP-III) guidelines. How these new recommendations impact adults with HIV-infection is unknown.
Methods: We used the Veterans Affairs (VA) Clinical Case Registry (CCR), one of the largest clinical databases of HIV-infected patients worldwide, to determine the impact of the new the new cholesterol guidelines on statin recommendations for HIV-infected veterans. Electronically available laboratory, medication, and comorbidity data from 2008 to 2010 were used to assess statin recommendations under the ATP-III and the 2013 AHA/ACC guidelines among male patients aged 40 to 75 years. Descriptive statistics are presented comparing the proportion of adults recommended under each guideline.
Results: 13293 male veterans with HIV-infection met inclusion criteria for the analysis. The average age was 54.6 years. Cardiovascular disease was present in 8.2% and diabetes in 15.4%. Of 13293 veterans, 5185 (39.0%) had been prescribed statin therapy (32.2% for primary prevention and 6.8% for secondary prevention). Overall, 11.6% of adults not previously eligible for statin therapy under ATP-III were newly recommended under ACC/AHA guidelines, with 7085 (53.3%) veterans recommended for statin therapy under the ATP-III guidelines compared to 8630 (64.9%) under the ACC/AHA guidelines. The majority of the increase in statin eligibility was in adults recommended for primary prevention; with 9.1% newly recommended based on 10-year risk score, 1.7% newly recommended based on diabetes, and 0.8% newly recommended based on presence of CVD.
Conclusions: In our study population of HIV-infected veterans, application of the new ACC/AHA cholesterol guidelines resulted in an approximate 12% absolute increase in the proportion of patients for whom statin therapy is indicated. The increased recommended use of statins is primarily related to risk assessed by the 10-year risk score of cardiovascular disease. It will be important to assess the benefit of this expanded prevention measure prospectively.