Journal of AIDS & Clinical Research

Underutilization of Statins for Prevention of Cardiovascular Disease among Primarily African-American HIV-Infected Patients

Abstract

Shashwatee Bagchi, Pankti Patel, Rawan Faramand, Shana Burrowes, Mian B. Hossain, Shyamasundaran Kottilil, Michael Miller, Lori E. Fantry and Robert R. Redfield

Background: Studies have consistently demonstrated that statin therapy reduces CHD-related mortality, but HIVinfected individuals are frequently undertreated for hyperlipidemia. Therefore, we sought to: 1. determine whether the numbers of patients recommended for statin therapy differed using the 2004 and 2013 guidelines; 2. evaluate the proportion of recommended patients who were actually receiving statins; and 3. evaluate the factors associated with statin prescription.

Methods: Conducted cross-sectional analysis of a retrospective cohort. 100 patients receiving care at an academic inner-city HIV clinic in 2008 were reviewed. The atherosclerotic vascular disease (ASCVD) risk score was calculated using the 2013 Pooled Cohort Equation and the 2004 and 2013 guidelines were applied to evaluate numbers of patients recommended for statin therapy. Proportions were used to report patients receiving statins among those who were recommended for treatment and several unadjusted logistic regression analyses were performed to identify factors associated with utilization of statins in recommended patients.

Results: 81 participants were included in the final analysis. Substantially larger numbers of HIV-infected individuals were recommended to receive statin therapy for CHD risk reduction when applying the 2013 guidelines compared to the 2004 guidelines, but less than half received statins for primary prevention as recommended. Prescription of statins was not associated with either ASCVD risk score or many traditional CHD risk factors. Diabetes mellitus was associated with increased odds of receiving statin therapy whereas hepatitis C co-infection and current smoking status were associated with decreased odds of receiving statins.

Conclusions: There is an increased, large and unmet need to increase statin use for prevention of CHD. Underutilization of statins was most pronounced among HIV-hepatitis C co-infected patients and HIV-infected smokers.

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