Despite the elevated risk of heart disease associated with HIV, only about a third of those at a major St. Louis HIV clinic who were indicated for use of a cholesterol-lowering statin medication were actually receiving one, the National AIDS Treatment Advocacy Project (NATAP) reports.
This study of January to December 2015 medical records of 1,085 HIV-positive people 40 or older was presented at the IDWeek 2017 conference in San Diego. It follows a study that reached similar findings about low statin use at a Chicago HIV clinic.
The researchers examined statin use according to 2013 guidelines from the American College of Cardiology and the American Heart Association (ACC/AHA). They divided the members of the St. Louis study cohort into four risk categories according to those with:
- Clinical atherosclerotic cardiovascular disease (ASCVD, the buildup of fats, cholesterol and other substances in and on the walls of arteries)
- LDL cholesterol of 190 or greater
- Diabetes and LDL of 70 to 189 with diabetes but without ASCVD who were 40 to 75 years old
- LDL of 70 to 189 without ASCVD or diabetes who had a 10-year estimated risk of developing ASCVD of 7.5 percent or greater and who were 40 to 75 years old.
The cohort members were 62 years old on average. Sixty-eight percent were Black, 31 percent were white and 71 percent were men. Forty-five percent were smokers. Ninety-eight percent were on antiretrovirals (ARVs) and 86 percent had a fully suppressed viral load. Fifty-six percent had high blood pressure, 16 percent had diabetes, 9 percent had chronic kidney disease and 5 percent had coronary artery disease.
Of 449 individuals who were indicated for a statin according to ACA/AHA guidelines, 289 (64 percent) were not on one. The proportions not taking a statin in each of the four risk categories were: group 1) 78 of 121 people (64 percent); group 2) five of nine (56 percent); group 3) 55 of 107 (51 percent); and group 4) 151 of 213 (71 percent). The proportion of those on statins in each of the four risk groups who were taking low-dose statins were a respective 56 percent, 25 percent, 63 percent and 64 percent.
Those with a higher CD4 count and those with an undetectable viral load were more likely to be on a statin. The average CD4 count among those on a statin was 630, compared with 537 among those not on a statin. A respective 93 percent and 88 percent of those on and off a statin had an undetectable viral load.
To read the NATAP report, click here.