Those aging with HIV have a higher risk of cardiovascular disease (CVD) than uninfected adults. Statins are hypothesized to impact traditional CVD risk factors, such as low-density lipoprotein (LDL) cholesterol, and may impact HIV-specific mechanisms, such as inflammation and immune activation. The objective of this study was to estimate the statin treatment gap, defined as the proportion eligible but not prescribed statins among HIV-infected adults.
Data from 14 dynamic clinical cohorts in the North American AIDS Cohort Collaboration on Research and Design were used to estimate trends in statin prescription. The statin treatment gap was defined using the final Adult Treatment Panel III guidelines as ≤1 risk factors and LDL ≥190 mg/dL, or ≥2 risk factors with 10-year predicted Framingham Risk Score (FRS) 0-20% and LDL ≥130 mg/dL, or diabetes and FRS >20% and LDL ≥130 mg/dL. The treatment gap analysis was restricted to those who had measurements needed to determine statin eligibility. Log binomial models with generalized estimating equations for repeated measures and an ordinal variable for calendar time were used to estimate the p-value for trend.
A total of 88,463 and 40,898 adults contributed to the estimation of the trends in statin prescription and the statin treatment gap, respectively. There were a greater proportion who were white and MSM in the gap compared with the prescription study populations (48% vs 39% p<.001 and 56% vs 49% p<.001, respectively). Over time, the proportion prescribed statins increased from 5% to 17% (p-trend<.001) (Figure 1). The statin treatment gap was large, but decreased from 70% to 58% (p-trend<.001). The gap was largest for males (72% to 59%), those with injection drug use HIV transmission risk (81% to 58%), and ever smokers (73% to 60%; all p-trend<.001). By age, the gap was largest and fluctuated among those <40 years with no clear trend (77% to 88% p-trend=.01). The decrease in the gap was similar among whites (72% to 57%) and blacks (71% to 58%), and larger in Hispanics (74% to 65%; all p-trend<.001).
The statin treatment gap was substantial from 2003 through 2012, prior to statin guideline changes in 2013. The gap may be underestimated due to the differences in the prescription and gap populations. Given the increased risk of CVD in HIV-infected adults, further narrowing the gap between statin eligibility and prescription may preserve the health of those aging with HIV.