1
|
Heintzman J, Kaufmann J, Rodriguez CJ, Lucas JA, Boston D, April-Sanders AK, Chung-Bridges K, Marino M. Statin Eligibility and Prescribing Across Racial, Ethnic, and Language Groups over the 2013 ACC/AHA Guideline Change: a Retrospective Cohort Analysis from 2009 to 2018. J Gen Intern Med 2023; 38:2970-2979. [PMID: 36977971 PMCID: PMC10593667 DOI: 10.1007/s11606-023-08139-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Accepted: 03/03/2023] [Indexed: 03/30/2023]
Abstract
BACKGROUND It is uncertain if the American College of Cardiology/American Heart Association (ACC/AHA) 2013 guidelines for the use of HMGCoA reductase inhibitors (statins) were associated with increased statin eligibility and prescribing across underserved groups. OBJECTIVE To analyze, by race, ethnicity, and preferred language, patients with indications for and presence of a statin prescription before and after the guideline change. DESIGN Retrospective cohort study. SETTING Multistate community health center (CHC) network with linked electronic health records. PATIENTS Low-income patients aged ≥ 50 with a primary care visit in 2009-2013 or 2014-2018. MAIN MEASURES (1) Odds of each race/ethnicity/language group meeting statin eligibility via the National Cholesterol Education Program Adult Treatment Panel III Guidelines in 2009-2013 or the ACC/AHA guidelines in 2014-2018. (2) Among those eligible, odds of each group in each period with a statin prescription. KEY RESULTS In 2009-2013 (n = 109,330), non-English-preferring Latino (OR = 1.10, 95% CI = 1.03, 1.17), White (OR = 1.41, 95% CI = 1.16, 1.72), and Black patients (OR = 1.25, 95% CI = 1.11, 1.42), were more likely than English-preferring non-Hispanic Whites to meet guideline criteria for statins. Non-English-preferring Black patients, when eligible, were no more likely than non-Hispanic Whites to have statin prescriptions (OR = 1.16, 95% CI = 0.88, 1.54). In 2014-2018 (n = 319,904), English-preferring Latino patients (OR = 1.02, 95% CI = 0.96-1.07) and non-English-preferring Black patients (OR = 1.08, 95% CI = 0.98, 1.19) had similar odds of statin prescription to English-preferring non-Hispanic White patients. English-preferring Black patients were less likely (OR = 0.95, 95% CI = 0.91-0.99) to have a prescription than English-preferring non-Hispanic Whites. CONCLUSION Across the 2013 ACC/AHA guideline change in CHCs serving low-income patients, non-English-preferring patients were consistently more likely to be eligible for and have been prescribed statins. English-preferring Latino and English-preferring Black patients experienced reduced prescribing, comparatively, after the guideline change. Further work should explore the contextual factors that may influence guideline effectiveness and care equity.
Collapse
Affiliation(s)
- John Heintzman
- Oregon Health and Science University, Portland, OR, USA.
- OCHIN Inc., Portland, OR, USA.
- PRIMER Lab, Portland, OR, USA.
| | - Jorge Kaufmann
- Department of Family Medicine, Oregon Health and Science University, Portland, OR, USA
| | - Carlos J Rodriguez
- Albert Einstein College of Medicine, Jack and Pearl Resnick Campus, Bronx, NY, USA
| | - Jennifer A Lucas
- Department of Family Medicine, Oregon Health and Science University, Portland, OR, USA
| | | | - Ayana K April-Sanders
- Department of Biostatistics & Epidemiology, Rutgers School of Public Health, Piscataway, NJ, USA
| | | | - Miguel Marino
- PRIMER Lab, Portland, OR, USA
- Department of Family Medicine, Oregon Health and Science University, Portland, OR, USA
| |
Collapse
|
2
|
High Concordance between D:A:Dr and the Framingham Risk Score in Brazilians Living with HIV. Viruses 2023; 15:v15020348. [PMID: 36851562 PMCID: PMC9960260 DOI: 10.3390/v15020348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 01/18/2023] [Accepted: 01/20/2023] [Indexed: 01/27/2023] Open
Abstract
People living with HIV (PLHIV) have twice the risk of developing cardiovascular diseases, making it essential to identify high cardiovascular risk (CVR). However, there is no validated CVR calculator for PLHIV in Brazil. We performed a cross-sectional study with 265 individuals living with HIV, aged 40 to 74 years, to assess the agreement between three CVR scores: Framingham Risk Score (FRS), Atherosclerotic Cardiovascular Disease (ASCVD) Risk Score, and a specific for PLHIV, Reduced Data Collection on Adverse Effects of Anti-HIV Drugs (D:A:Dr). We assessed agreement using the weighted Kappa coefficient and the Bland-Altman plot. The median age was 52 years (47-58), 58.9% were men, 34% were hypertensive and 8.3% had a detectable viral load. There was an almost perfect agreement between D:A:Dr x FRS (k = 0.82; 95% CI 0.77-0.87; p < 0.001), and substantial agreement between FRS vs. ASCVD (k = 0.74; 95% CI 0.69-0.79; p < 0.001) and between D:A:Dr vs. ASCVD (k = 0.70; 95% CI 0.64-0.76; p < 0.001). The Bland-Altman plot revealed greater discordance between scores as the CVR increased. Our results suggest that the FRS and the D:A:Dr are adequate to classify the CVR in this population, and the D:A:Dr score can be used as an alternative to the FRS in Brazil, as other international guidelines have already advocated.
Collapse
|
3
|
Chen Q, Fan L, Xu Y. Efficacy of metoprolol plus atorvastatin for carotid atherosclerosis and its influence on carotid intima-media thickness and homocysteine level. Am J Transl Res 2022; 14:5511-5519. [PMID: 36105018 PMCID: PMC9452315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Accepted: 07/05/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVE To analyze the effects of metoprolol (MET) plus atorvastatin (ATO) on carotid intima-media thickness (IMT) and homocysteine (Hcy) level in carotid atherosclerosis (CAS) patients. METHODS In this retrospective study, 90 patients with CAS admitted to the Hangzhou Ninth People's Hospital between January 2019 and July 2021 were enrolled, including 40 cases (control group, the Con) treated with MET and 50 cases treated with the combination therapy of MET plus ATO (Research group, the Res). The efficacy and related influencing factors were observed and compared. The clinical effects (IMT, plaque score), Hcy level, inflammatory cytokines (ICs; matrix metalloproteinase-9 [MMP-9], high-sensitivity C-reactive protein [hs-CRP]), blood lipid indices (low-/high- density lipoprotein cholesterol [LDL-C/HDL-C], total cholesterol [TC], triglyceride [TG]) and coagulation markers (thrombin time [TT], prothrombin time [PT], activated partial thromboplastin time [APTT], fibrinogen [FIB]) of the two groups were observed and compared. RESULTS The results identified a statistically higher overall response rate in the Res group. Age, coronary heart disease, cerebral infarction and plaque score were confirmed to be closely related to the efficacy of CAS. In addition, statistically lower post-treatment IMT, plaque score, MMP-9, hs-CRP, LDL-C, TG, TC and FIB while higher PT, TT and APTT were determined in the Res group compared with the pre-treatment values and the Con group. CONCLUSIONS MET plus ATO can significantly improve efficacy, reduce IMT and plaque score of patients with CAS, as well as improve inflammatory factors, blood lipid indices and coagulation markers, for which it deserves clinical promotion.
Collapse
Affiliation(s)
- Qiuping Chen
- Department of Cardiology, Hangzhou Ninth People's Hospital Hangzhou 310000, Zhejiang, China
| | - Linglong Fan
- Department of Cardiology, Hangzhou Ninth People's Hospital Hangzhou 310000, Zhejiang, China
| | - Yunshu Xu
- Department of Cardiology, Hangzhou Ninth People's Hospital Hangzhou 310000, Zhejiang, China
| |
Collapse
|
4
|
Kapelios CJ, Masouris G, Argyris A, Konstantinidis I, Gamaletsou MN, Kontos A, Zormpala A, Spiliopoulos S, Sipsas NV, Protogerou AD. Detection of Subclinical Coronary Artery Lesions by Framingham Risk Score, Peripheral Artery Atheromatosis and Coronary Artery Calcium Score: A Pilot Study in Asymptomatic Individuals Living with HIV. AIDS Res Hum Retroviruses 2021; 37:343-349. [PMID: 33749336 DOI: 10.1089/aid.2021.0015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
The incidence of acute coronary events is increased among people living with HIV (PLWH), but there is no risk estimation score, nor a surrogate biomarker able to predict subclinical coronary artery disease (sCAD). We assessed the performance of: (i) Framingham risk score (FRMs), (ii) peripheral (carotid and femoral) artery atheromatosis, and (iii) coronary artery calcium (CACs) score, to detect the presence of sCAD, in PLWH. In a cohort of PLWH free of cardiovascular disease (CVD), we measured sCAD and CACs by computed tomography, calculated FRMs, and assessed carotid/femoral plaques by ultrasound. In 56 participants (age: 49 ± 10 years, men: 88%, FRMs: 7.2 ± 6.9; mean number of carotid/femoral plaques: 1.4 ± 1.5; CACs >0 present in 59%, median CACs 0.9 [IQR 0-22]): (i) minimal sCAD (stenosis 1%-24%; present in 30%) and mild sCAD (25%-49%, 25%) were effectively detected by FRMs, number of plaques, and CACs [area under the curve (AUC) of CACs was better than that of both FRM and plaques, p < .05]; (ii) moderate sCAD (stenosis 50%-69%; present in 8.9%) was detected by number of plaques and CACs, but similar AUC (0.969 vs. 0.867, respectively, p = NS); and (iii) severe sCAD (70%-99%, present in only 3 [5.4%]) was detected only by CACs. A high prevalence of sCAD in asymptomatic PLWH free of CVD was detected; CACs is a highly efficient biomarker to detect all grades of sCAD, however, the number of carotid/femoral plaques combined is also a very promising-lower cost and radiation free-surrogate biomarker. Future, larger studies are needed to verify these results.
Collapse
Affiliation(s)
- Chris J Kapelios
- Department of Cardiology, Laiko General Hospital, Athens, Greece
| | - Giorgos Masouris
- Cardiovascular Prevention & Research Unit, Clinic and Laboratory of Pathophysiology, National and Kapodistrian University of Athens School of Medicine, Athens, Greece
| | - Antonis Argyris
- Cardiovascular Prevention & Research Unit, Clinic and Laboratory of Pathophysiology, National and Kapodistrian University of Athens School of Medicine, Athens, Greece
| | - Ippokratis Konstantinidis
- Infectious Diseases Unit, Department of Pathophysiology, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Maria N Gamaletsou
- Infectious Diseases Unit, Department of Pathophysiology, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Athanasios Kontos
- Infectious Diseases Unit, Department of Pathophysiology, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Alexandra Zormpala
- CT Unit, Radiology Department, General Hospital of Athens Laiko, Athens, Greece
| | - Stavros Spiliopoulos
- 2nd Department of Radiology, National and Kapodistrian University of Athens School of Medicine, Athens, Greece
| | - Nikolaos V Sipsas
- Infectious Diseases Unit, Department of Pathophysiology, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Athanase D Protogerou
- Cardiovascular Prevention & Research Unit, Clinic and Laboratory of Pathophysiology, National and Kapodistrian University of Athens School of Medicine, Athens, Greece
| |
Collapse
|
5
|
de Oliveira Salvador GL. Facing a new paradigm: Not retreating but advancing in another direction. Eur J Prev Cardiol 2021; 28:324-325. [PMID: 33611417 DOI: 10.1177/2047487320912899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
|
6
|
Saumoy M, Di Yacovo S, Pérez S, Sánchez-Quesada JL, Valdivielso JM, Subirana I, Imaz A, Tiraboschi JM, García B, Ordoñez-LLanos J, Benítez S, Podzamczer D, Grau M. Carotid atherosclerosis in virologically suppressed HIV patients: comparison with a healthy sample and prediction by cardiovascular risk equations. HIV Med 2021; 22:581-591. [PMID: 33817938 DOI: 10.1111/hiv.13093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 01/04/2021] [Accepted: 01/28/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To compare the prevalence of carotid atherosclerosis in virologically suppressed HIV patients with that of a community sample, and to evaluate the capacity of various cardiovascular risk (CVR) equations for predicting carotid atherosclerosis. METHODS This was a cross-sectional study with two randomly selected groups: HIV patients from an HIV unit and a control group drawn from the community. Participants were matched by age (30-80 years) and sex without history of cardiovascular disease. Carotid plaque, common carotid intima-media thickness (cc-IMT) and subclinical atherosclerosis (carotid plaque and/or cc-IMT > 75th percentile) were assessed by carotid ultrasound. The Systematic Coronary Risk Evaluation (SCORE), Framingham, REGICOR, reduced Data Collection on Adverse Effects of Anti-HIV Drugs (D:A:D), and COMVIH equations were applied, and their abilities to predict carotid plaque were compared using the area under the curve (AUC). RESULTS Each group included 379 subjects (77.8% men, age 49.7 years). Duration of antiretroviral therapy was 15.5 years. There were no differences between the groups for carotid plaque (HIV, 33.2%; control, 31.3%), mean cc-IMT (HIV, 0.63 mm; control, 0.61 mm) or subclinical atherosclerosis (HIV, 42.9%; control, 47.9%). Thymidine analogues were independently associated with subclinical atherosclerosis in HIV-infected patients. CVR equations revealed AUCs between 0.715 and 0.807 for prediction of carotid plaque; prediction was better in the control group and did not improve when HIV-adapted scales were used. CONCLUSIONS The features of carotid atherosclerosis did not differ between the HIV-infected and the control group, although CVR equations were more predictive for carotid plaque in controls than in HIV-infected patients. HIV-specific equations did not improve prediction.
Collapse
Affiliation(s)
- M Saumoy
- HIV and STD Unit, Infectious Disease Department, Bellvitge University Hospital, Hospitalet de Llobregat, Spain.,Bellvitge Institute for Biomedical Research, Hospitalet de Llobregat, Spain
| | - S Di Yacovo
- HIV and STD Unit, Infectious Disease Department, Bellvitge University Hospital, Hospitalet de Llobregat, Spain.,Bellvitge Institute for Biomedical Research, Hospitalet de Llobregat, Spain
| | - S Pérez
- Hospital del Mar Institute for Medical Research (IMIM), Barcelona, Spain.,Consortium for Biomedical Research in Cardiovascular Diseases (CIBERCV), Barcelona, Spain
| | - J L Sánchez-Quesada
- Biomedical Research Institute IIB Sant Pau, Barcelona, Spain.,Biochemistry and Molecular Biology Department, Universitat Autònoma, Barcelona, Spain
| | - J M Valdivielso
- Biomedical Research Institute of Lleida, IRB, Vascular and Renal Translational Research Group, UDETMA, Lleida, Spain
| | - I Subirana
- Hospital del Mar Institute for Medical Research (IMIM), Barcelona, Spain.,Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Barcelona, Spain
| | - A Imaz
- HIV and STD Unit, Infectious Disease Department, Bellvitge University Hospital, Hospitalet de Llobregat, Spain.,Bellvitge Institute for Biomedical Research, Hospitalet de Llobregat, Spain
| | - J M Tiraboschi
- HIV and STD Unit, Infectious Disease Department, Bellvitge University Hospital, Hospitalet de Llobregat, Spain.,Bellvitge Institute for Biomedical Research, Hospitalet de Llobregat, Spain
| | - B García
- HIV and STD Unit, Infectious Disease Department, Bellvitge University Hospital, Hospitalet de Llobregat, Spain
| | - J Ordoñez-LLanos
- Biomedical Research Institute IIB Sant Pau, Barcelona, Spain.,Biochemistry and Molecular Biology Department, Universitat Autònoma, Barcelona, Spain
| | - S Benítez
- Biochemistry and Molecular Biology Department, Universitat Autònoma, Barcelona, Spain
| | - D Podzamczer
- HIV and STD Unit, Infectious Disease Department, Bellvitge University Hospital, Hospitalet de Llobregat, Spain.,Bellvitge Institute for Biomedical Research, Hospitalet de Llobregat, Spain
| | - M Grau
- Hospital del Mar Institute for Medical Research (IMIM), Barcelona, Spain.,Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Barcelona, Spain.,Department of Medicine, University of Barcelona, Barcelona, Spain
| |
Collapse
|
7
|
Bonou M, Kapelios CJ, Athanasiadi E, Mavrogeni SI, Psichogiou M, Barbetseas J. Imaging modalities for cardiovascular phenotyping in asymptomatic people living with HIV. Vasc Med 2021; 26:326-337. [PMID: 33475050 DOI: 10.1177/1358863x20978702] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Cardiovascular disease (CVD) has emerged as a leading cause of non-HIV-related mortality among people living with HIV (PLWH). Despite the growing CVD burden in PLWH, there is concern that general population risk score models may underestimate CVD risk in these patients. Imaging modalities have received mounting attention lately to better understand the pathophysiology of subclinical CVD and provide improved risk assessment in this population. To date, traditional and well-established techniques such as echocardiography, pulse wave velocity, and carotid intima thickness continue to be the basis for the diagnosis and subsequent monitoring of vascular atherosclerosis and heart failure. Furthermore, novel imaging tools such as cardiac computed tomography (CT) and cardiac CT angiography (CCTA), positron emission tomography/CT (PET/CT), and cardiac magnetic resonance (CMR) have provided new insights into accelerated cardiovascular abnormalities in PLWH and are currently evaluated with regards to their potential to improve risk stratification.
Collapse
Affiliation(s)
- Maria Bonou
- Department of Cardiology Department, Laiko General Hospital, Athens, Greece
| | - Chris J Kapelios
- Department of Cardiology Department, Laiko General Hospital, Athens, Greece
| | - Eleni Athanasiadi
- Department of Cardiology Department, Laiko General Hospital, Athens, Greece
| | | | - Mina Psichogiou
- First Department of Internal Medicine, Laiko General Hospital, National and Kapodistrian University of Athens School of Medicine, Athens, Greece
| | - John Barbetseas
- Department of Cardiology Department, Laiko General Hospital, Athens, Greece
| |
Collapse
|
8
|
Progression of Subclinical Vascular Damage in People Living With HIV Is Not Predicted by Current Cardiovascular Risk Scores: A Prospective 3-Year Study. J Acquir Immune Defic Syndr 2020; 83:504-512. [PMID: 31923089 DOI: 10.1097/qai.0000000000002286] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
BACKGROUND People living with HIV (PLWH) are at high cardiovascular disease (CVD) risk. Traditional CVD risk scores do not accurately reflect their CVD risk. Noninvasive subclinical vascular damage (SVD) biomarkers are valid surrogates of CVD and able to stratify CVD risk. SETTING We tested whether 4 widely applied CVD risk scores [Framingham (FRS), Atherosclerotic CVD, Data Collection on Adverse Effects of Anti-HIV Drugs Study (D:A:D), and Greek-specific European Society of Cardiology (ESC) risk scores] are associated with or detect the presence, incidence, and progression of arteriosclerosis, atheromatosis, and arterial hypertrophy in PLWH and uninfected individuals. METHODS We prospectively examined (at baseline and 3-year follow-up) 10 different arterial sites applying 5 different noninvasive vascular biomarkers and measured all 4 CVD risk scores at baseline. RESULTS In both PLWH (n = 138) and uninfected (n = 664) individuals, the CVD risk scores (except the ESC) performed differently but reasonably well in identifying the presence of SVD, but all scores failed to predict the incidence/progression of overall SVD. The most clinically useful biomarkers (carotid plaque/atheromatosis) revealed that in PLWH, only the FRS was able to stratify the progression (11% of the low-risk, 33.3% of the medium-risk, and 0% of the high-risk group). CONCLUSIONS This extensive vascular phenotyping study demonstrated the clear need to incorporate vascular imaging in CVD risk stratification, in addition to designing more accurate HIV-specific CVD risk models. The use of FRS would further enable treatment optimization and CVD prevention strategies in PLWH at medium CVD risk because one-third of carotid atheromatosis progresses within 3 years.
Collapse
|
9
|
McLaughlin MM, Ma Y, Scherzer R, Rahalkar S, Martin JN, Mills C, Milush J, Deeks SG, Hsue PY. Association of Viral Persistence and Atherosclerosis in Adults With Treated HIV Infection. JAMA Netw Open 2020; 3:e2018099. [PMID: 33119103 PMCID: PMC7596582 DOI: 10.1001/jamanetworkopen.2020.18099] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
IMPORTANCE Persons living with HIV (PLWH) have increased risk for cardiovascular disease, and inflammation is thought to contribute to this excess risk. Production of HIV during otherwise effective antiretroviral therapy (ART) has been associated with inflammation. OBJECTIVE To determine whether higher levels of viral persistence are associated with atherosclerosis as assessed by changes in carotid artery intima-media thickness (IMT) over time. DESIGN, SETTING, AND PARTICIPANTS In this cohort study, intima-media thickness, a validated marker of atherosclerosis, was assessed over time in a cohort of treated PLWH with viral suppression. Cell-associated HIV DNA and RNA and change in IMT, adjusted for demographics, cardiovascular risk factors, and HIV-related factors, were examined, as well as which factors were associated with viral persistence. One hundred fifty-two PLWH with undetectable viral loads for at least 6 months before study enrollment were recruited from HIV clinics affiliated with 2 hospitals in San Francisco, California, from January 1, 2003, to December 31, 2012. Data were analyzed from February 7, 2018, to May 12, 2020. EXPOSURES Cell-associated HIV RNA and DNA were measured using enriched CD4+ T cells from cryopreserved peripheral blood mononuclear cells. MAIN OUTCOMES AND MEASURES Carotid IMT was measured at baseline and the last visit, with a mean (SD) follow-up of 4.2 (2.7) years, using high-resolution B mode ultrasonography. The main study outcomes were baseline IMT, annual IMT progression, and incident plaque, defined as a focal region of carotid IMT of greater than 1.5 mm. RESULTS The analysis included 152 PLWH (140 [92.1%] male; median age, 48.5 [interquartile range {IQR}, 43.3-53.7] years). Older age, smoking, medications for hypertension, higher low-density lipoprotein levels, and higher interleukin 6 levels were associated with higher baseline mean IMT, whereas cell-associated HIV DNA (estimate, -0.07% [95% CI, -6.1% to 6.4%]; P = .98), and HIV RNA levels (estimate, -0.8% [95% CI, -5.9% to 4.4%]; P = .75) were not. Levels of HIV RNA (0.017 [95% CI, 0.000-0.034] mm/y; P = .047) and HIV DNA (0.022 [95% CI, 0.001-0.044] mm/y; P = .042) were significantly associated with annual carotid artery IMT progression in unadjusted models only. Both HIV RNA (incidence risk ratio [IRR], 3.05 [95% CI, 1.49-6.27] per IQR; P = .002) and HIV DNA (IRR, 3.15 [95% CI, 1.51-6.57] per IQR; P = .002) were significantly associated with incident plaque, which remained significant after adjusting for demographics, cardiovascular risk factors, and HIV-related factors (IRR for HIV RNA, 4.05 [95% CI, 1.44-11.36] per IQR [P = .008]; IRR for HIV DNA, 3.35 [95% CI, 1.22-9.19] per IQR [P = .02]). Higher C-reactive protein levels were associated with higher cell-associated HIV RNA (estimate, 20.7% [95% CI, 0.9%-44.4%] per doubling; P = .04), whereas higher soluble CD14 levels were associated with HIV DNA (estimate, 18.6% [95% CI, 3.5%-35.8%] per 10% increase; P = .01). Higher soluble CD163 levels were associated with a higher HIV RNA:DNA ratio (difference, 63.8% [95% CI, 3.5%-159.4%]; P = .04). CONCLUSIONS AND RELEVANCE These findings suggest that measurements of viral persistence in treated HIV disease are independently associated with incident carotid plaque development. The size and transcriptional activity of the HIV reservoir may be important contributors to HIV-associated atherosclerosis.
Collapse
Affiliation(s)
| | - Yifei Ma
- Department of Medicine, San Francisco Veterans Affairs Medical Center, UCSF
| | - Rebecca Scherzer
- Department of Medicine, San Francisco Veterans Affairs Medical Center, UCSF
| | - Smruti Rahalkar
- Division of Cardiology, Department of Medicine, San Francisco General Hospital, UCSF
| | | | - Claire Mills
- Division of Cardiology, Department of Medicine, San Francisco General Hospital, UCSF
| | - Jeffrey Milush
- Department of Medicine, Division of Experimental Medicine, UCSF
| | - Steven G. Deeks
- Positive Health Program, San Francisco General Hospital, San Francisco, California
| | - Priscilla Y. Hsue
- Division of Cardiology, Department of Medicine, San Francisco General Hospital, UCSF
| |
Collapse
|
10
|
Dai L, Liu A, Zhang H, Wu H, Zhang T, Su B, Shao Y, Li J, Ye J, Scott SR, Mahajan SD, Schwartz SA, Yu H, Sun L. Impact of Lopinavir/Ritonavir and Efavirenz-Based Antiretroviral Therapy on the Lipid Profile of Chinese HIV/AIDS Treatment-Naïve Patients in Beijing: A Retrospective Study. Curr HIV Res 2020; 17:324-334. [PMID: 31654514 DOI: 10.2174/1570162x17666191025115508] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Revised: 10/16/2019] [Accepted: 10/18/2019] [Indexed: 12/21/2022]
Abstract
BACKGROUND Antiretroviral therapy (ART) is associated with lipid abnormalities that contribute to increased risk of cardiovascular (CV) events among patients with human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS). Although disorders of lipid metabolism associated with ART have been described before in developed countries, data on lipid profile disorders associated with ART use in China are limited. This study aimed to examine the changes in lipid profile among patients with HIV/AIDS who initiated lopinavir/ritonavir LPV/r or efavirenz (EFV)-based antiretroviral treatment regimens, which continue to be widely used China and other developing countries. METHODS This is a retrospective, matched case-control study of HIV-positive patients initiating either LPV/r or EFV regimens at the Beijing You'an Hospital, Capital Medical University between July 2012 and January 2017. Generalized estimating equations were used to compare the differences in total cholesterol [TC], triglycerides [TG], low-density lipoprotein-cholesterol [LDL-C], and highdensity lipoprotein-cholesterol [HDL-C] at baseline and up to 24-months after ART initiation between the two treatment arms. RESULTS Baseline characteristics, including age, sex, CD4 cell count, viral load, and serum lipids, which were comparable between the two groups. The LPV/r-based regimen group had increased TC, TG, HDL-C, and LDL-C after 24-months of treatment. In the EFV-regimen group, TC, HDL-C, and LDL-C were increased compared to baseline, while the TC/HDL-C ratio decreased, and TG did not change significantly. After 24-months of treatment, the percentage of patients with dyslipidemia in the LPV/r group was much higher than in the EFV group (84.0% vs. 52.6%, P<0.001), and 17(10%) patients on LPV/r-based regimens had severe dyslipidemia. Patients on LPV/r-based regimens were at increased odds of hypercholesterolemia (odds ratio [OR]=1.709, P=0.038), hypertriglyceridemia (OR=4.315, P<0.001), and high TC/HDL-C ratio (OR=1.951, P=0.003). However, no significant difference was found in HDL-C (OR=1.246, P=0.186) or LDL-C (OR=1.253, P=0.410) between the treatment groups. CONCLUSION Both LPV/r or EFV treatment regimens impacted patients' lipid profiles. Compared to EFV-based regimens, patients on LPV/r-based regimens had increased odds of dyslipidemia, such as hypercholesterolemia, hypertriglyceridemia, or high TC/HDL-C ratio; however, there was no obvious effect on LDL-C, which is more relevant to the development of the cardiovascular disease.
Collapse
Affiliation(s)
- Lili Dai
- Department of Infectious Disease, You'an Hospital Affiliated to the Capital Medical University, Beijing 100069, China
| | - An Liu
- Department of Infectious Disease, You'an Hospital Affiliated to the Capital Medical University, Beijing 100069, China
| | - Hongwei Zhang
- Department of Infectious Disease, You'an Hospital Affiliated to the Capital Medical University, Beijing 100069, China
| | - Hao Wu
- Department of Infectious Disease, You'an Hospital Affiliated to the Capital Medical University, Beijing 100069, China
| | - Tong Zhang
- Department of Infectious Disease, You'an Hospital Affiliated to the Capital Medical University, Beijing 100069, China
| | - Bin Su
- Department of Infectious Disease, You'an Hospital Affiliated to the Capital Medical University, Beijing 100069, China
| | - Ying Shao
- Department of Infectious Disease, You'an Hospital Affiliated to the Capital Medical University, Beijing 100069, China
| | - Jianwei Li
- Department of Infectious Disease, You'an Hospital Affiliated to the Capital Medical University, Beijing 100069, China
| | - Jiangzhu Ye
- Department of Infectious Disease, You'an Hospital Affiliated to the Capital Medical University, Beijing 100069, China
| | - Sarah Robbins Scott
- National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Supriya D Mahajan
- Department of Medicine, Division of Allergy, Immunology & Rheumatology, University at Buffalo, Clinical & Translational Research Center, Buffalo, NY 14203, United States
| | - Stanley A Schwartz
- Department of Medicine, Division of Allergy, Immunology & Rheumatology, University at Buffalo, Clinical & Translational Research Center, Buffalo, NY 14203, United States
| | - Hongwei Yu
- Department of Infectious Disease, You'an Hospital Affiliated to the Capital Medical University, Beijing 100069, China
| | - Lijun Sun
- Department of Infectious Disease, You'an Hospital Affiliated to the Capital Medical University, Beijing 100069, China
| |
Collapse
|
11
|
Hester EK, Caulder CR, Penzak SR. Impact of team‐based care on appropriate statin therapy prescribing in ***HIV‐infected patients. JOURNAL OF THE AMERICAN COLLEGE OF CLINICAL PHARMACY 2020. [DOI: 10.1002/jac5.1206] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
- Elizabeth K. Hester
- Department of Pharmacy Practice Auburn University Harrison School of Pharmacy Auburn Alabama
| | - Celeste R. Caulder
- Department of Clinical Pharmacy and Outcomes Sciences University of South Carolina College of Pharmacy Columbia South Carolina
| | - Scott R. Penzak
- Department of Pharmacy Practice Auburn University Harrison School of Pharmacy Auburn Alabama
| |
Collapse
|
12
|
Phan BAP, Ma Y, Scherzer R, Deeks SG, Hsue PY. Association between statin use, atherosclerosis, and mortality in HIV-infected adults. PLoS One 2020; 15:e0232636. [PMID: 32353062 PMCID: PMC7192415 DOI: 10.1371/journal.pone.0232636] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Accepted: 04/17/2020] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND While HIV infection is associated with increased cardiovascular risk, benefit from statin is not well established in HIV-infected adults. We assessed whether statins are associated with a decrease in carotid artery intima-media thickness (cIMT) progression and all-cause mortality in HIV-infected adults who are at elevated ASCVD risk and recommended for statins. METHODS Carotid IMT was measured at baseline and follow-up in 127 HIV-infected adults who meet ACC/AHA criteria to be on statins. Inverse probability of treatment weighting (IPTW) was used to address selection bias. Multivariable models were used to control for baseline characteristics. RESULTS 28 subjects (22%) were on statins and 99 subjects (78%) were not. Mean cIMT at baseline was 1.2 mm (SD = 0.34) in statin users and 1.1 mm (SD = 0.34) in non-users, and the multivariable adjusted difference was 0.05mm (95%CI -0.11, 0.21 p = 0.53). After 3.2 years of follow-up, average cIMT progression was similar in statin users and non-users (0.062mm/yr vs. 0.058 mm/yr) and the multivariable adjusted difference over the study period was 0.004 mm/yr (95% CI -0.018, 0.025, p = 0.74). All-cause mortality appeared higher in non-statin users compared with statin users, but the difference was not significant (adjusted HR = 0.74, 95%CI 0.17-3.29, p = 0.70). CONCLUSION In a HIV cohort who had elevated ASCVD risk and meet ACC/AHA criteria for statins, treatment with statins was not associated with a reduction in carotid atherosclerosis progression or total mortality. Future studies are needed to further explore the impact of statins on cardiovascular risk in the HIV-infected population.
Collapse
Affiliation(s)
- Binh An P. Phan
- Division of Cardiology, San Francisco General Hospital, Department of Medicine, University of California, San Francisco, California, United States of America
| | - Yifei Ma
- Division of Cardiology, San Francisco General Hospital, Department of Medicine, University of California, San Francisco, California, United States of America
| | - Rebecca Scherzer
- San Francisco Veteran’s Affairs Medical Center and Department of Medicine, University of California, San Francisco, California, United States of America
| | - Steven G. Deeks
- Positive Health Program, San Francisco General Hospital, University of California, San Francisco, California, United States of America
| | - Priscilla Y. Hsue
- Division of Cardiology, San Francisco General Hospital, Department of Medicine, University of California, San Francisco, California, United States of America
| |
Collapse
|
13
|
Blackman AL, Pandit NS, Pincus KJ. Comparing rates of statin therapy in eligible patients living with HIV versus uninfected patients. HIV Med 2019; 21:135-141. [PMID: 31876122 DOI: 10.1111/hiv.12794] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/11/2019] [Indexed: 12/11/2022]
Abstract
OBJECTIVES Despite an increased risk of atherosclerotic cardiovascular disease (ASCVD) in people living with HIV (PLWH), a gap in statin prescribing practices has been described for statin-eligble PLWH and uninfected patients. Few data have become available characterizing this gap since the publication of the 2013 American College of Cardiology/American Heart Association lipid guidelines. The objective of this study was to characterize statin prescribing rates for eligible PLWH compared to uninfected adults. METHODS This was a retrospective, comparative analysis of patients seen at two clinics in an urban, academic medical system between February 2017 and September 2017. Patients who qualified for one of the statin benefit groups were included: those with a history of clinical ASCVD, low-density lipoprotein cholesterol ≥ 190 mg/dL, diabetes mellitus, or 10-year ASCVD risk score ≥ 7.5%. Patients < 21 years old or without a lipid panel within 3 years were excluded. The primary outcome was the percentage of PLWH prescribed a statin compared to uninfected patients. Predictors associated with receiving a statin were analysed using a logistic regression model. RESULTS Nine hundred and eight PLWH and 2239 uninfected patients met the study criteria. A difference in statin prescribing rates was observed between PLWH and uninfected patients (44% versus 56%, respectively; adjusted odds ratio (OR) 0.79; 95% confidence interval (CI) 0.66-0.94). However, only in the 10-year ASCVD risk group were the rates significantly different (24% for PLWH versus 36% for uninfected patients; adjusted OR 0.68; 95% CI 0.5-0.92). PLWH more often received a medium-intensity statin and uninfected patients more often received a high-intensity statin. CONCLUSIONS PLWH with ASCVD risk were less likely to be prescribed a statin compared to uninfected patients. Additional analyses are needed to investigate reasons for the statin prescribing gap and appropriateness of lipid agent selection in both study populations.
Collapse
Affiliation(s)
- A L Blackman
- Department of Pharmacy Practice and Sciences, University of Maryland School of Pharmacy, Baltimore, MD, USA
| | - N S Pandit
- Department of Pharmacy Practice and Sciences, University of Maryland School of Pharmacy, Baltimore, MD, USA
| | - K J Pincus
- Department of Pharmacy Practice and Sciences, University of Maryland School of Pharmacy, Baltimore, MD, USA
| |
Collapse
|
14
|
Abstract
OBJECTIVE Individuals with HIV suffer a higher burden of cardiovascular diseases. Traditional cardiovascular risk scores consistently underestimate cardiovascular risk in this population. Subsets of microRNAs (miRNAs) are differentially expressed among individuals with cardiovascular disease and individuals infected with HIV. However, no study has clarified whether specific miRNAs may be biomarkers for cardiovascular disease in individuals with HIV. DESIGN/METHODS We compared the miRNA expression profiles of 34 HIV-positive individuals who had experienced clinically adjudicated type I myocardial infarctions (MI) with the profiles of 76 HIV-positive controls matched by traditional cardiovascular risk factors and HIV-specific measures. Using the elastic net algorithm, we selected miRNAs most strongly associated with incident MI and then used conditional Cox proportional hazards regression and cross-validation to evaluate miRNAs and their association with incident MI. We evaluated whether miRNA markers would improve risk classification relative to the Framingham Risk Score. RESULTS Higher miR-125a-5p and miR-139-5p expression levels were each associated with increased risk of developing MI after adjustment for Framingham Risk Score and HIV-related factors (hazard ratio 2.43, P = 0.018; hazard ratio 2.13, P = 0.048, respectively). Compared with the Framingham Risk Score alone, adding expression levels of miR-125a-5p or miR-139-5p resulted in an integrated discrimination improvement of 10.1 or 5.8%, respectively. CONCLUSION MiR-125a-5p and miR-139-5p, transcripts known to be differentially expressed in HIV-positive individuals, may serve as unique biomarkers predictive of cardiovascular disease in these patients and may help clarify processes because of HIV infection that contribute to cardiovascular disorders in this population.
Collapse
|
15
|
Affiliation(s)
- Bhavesh Jarwani
- Department of Emergency Medicine, Trauma Center, VS General Hospital, Ahmedabad, Gujarat, India
| |
Collapse
|
16
|
Ryan T, Affandi JS, Gahungu N, Dwivedi G. Noninvasive Cardiovascular Imaging: Emergence of a Powerful Tool for Early Identification of Cardiovascular Risk in People Living With HIV. Can J Cardiol 2018; 35:260-269. [PMID: 30825948 DOI: 10.1016/j.cjca.2018.11.036] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Revised: 11/06/2018] [Accepted: 11/20/2018] [Indexed: 12/31/2022] Open
Abstract
Antiretroviral therapy (ART) has been pivotal in prolonging the lifespan of people living with HIV (PLWH). However, this also simultaneously increases their risk of cardiovascular disease (CVD) either related to ART, aging, hypertension, immunosenescence, inflammation, immune activation, or other comorbidities. Although the use of risk markers has greatly enhanced the field of cardiovascular (CV) medicine and improved the prognosis and early diagnosis in the general population, this strategy has not been clearly elucidated in PLWH. Developing accurate risk algorithms for PLWH requires an innate understanding of mechanistic factors influencing their risks. Early identification of CV risk will significantly enhance the prospects of PLWH living longer and relatively healthily. Herein, we discuss the use of multimodality noninvasive CV imaging as robust markers for ameliorating CV risk. The ability to prognosticate CV risk and hence prevent CV events in PLWH would represent an important advance in CV medicine, allowing precise detection and early institution of preventative strategies. Using novel CV imaging modalities and strategies would have a positive impact on precision medicine in this patient cohort.
Collapse
Affiliation(s)
- Timothy Ryan
- Fiona Stanley Hospital, Murdoch, Western Australia, Australia
| | - Jacquita S Affandi
- School of Public Health, Curtin University, Bentley, Western Australia, Australia; Harry Perkins Institute of Medical Research, Murdoch, Western Australia, Australia
| | - Nestor Gahungu
- Royal Perth Hospital, Perth, Western Australia, Australia
| | - Girish Dwivedi
- Fiona Stanley Hospital, Murdoch, Western Australia, Australia; Harry Perkins Institute of Medical Research, Murdoch, Western Australia, Australia; The University of Western Australia, Crawley, Western Australia, Australia.
| |
Collapse
|
17
|
Waters DD, Hsue PY. Lipid Abnormalities in Persons Living With HIV Infection. Can J Cardiol 2018; 35:249-259. [PMID: 30704819 DOI: 10.1016/j.cjca.2018.11.005] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Revised: 11/02/2018] [Accepted: 11/06/2018] [Indexed: 01/16/2023] Open
Abstract
Lipid abnormalities are prevalent among persons living with HIV infection and contribute to increasing the risk of cardiovascular events. Antiretroviral therapy (ART) is associated with lipid abnormalities, most commonly hypertriglyceridemia, but also increases in low-density lipoprotein cholesterol and total cholesterol. Different classes of ART, and different drugs within classes, have differing effects on lipid levels, but in general newer drugs have more favourable effects compared with older ones. Low-level inflammation and chronic immune activation act on lipids through a variety of mechanisms to make them more atherogenic. As a consequence, risk is higher than would be expected for any given cholesterol level. Clinical outcome trials of cholesterol-lowering therapies have not yet been completed in people living with HIV, so that treatment decisions depend on extrapolation from studies in uninfected populations. Traditional risk assessment tools underestimate cardiovascular risk in individuals with HIV. Statins are the mainstay of lipid-lowering drug treatment; however, drug-drug interactions with ART must be considered. Simvastatin and lovastatin are contraindicated in patients taking protease inhibitors, and the dose of atorvastatin and rosuvastatin should be limited to 40 mg and 10 mg/d with some ART combinations. Switching from older forms of ART to lipid-friendly newer ones is a useful strategy as long as virologic suppression is maintained, but adding a statin lowers low-density lipoprotein cholesterol more effectively. Studies indicate that lipid abnormalities are not treated as aggressively in individuals living with HIV as they are in uninfected people, making this an opportunity to improve care.
Collapse
Affiliation(s)
- David D Waters
- Division of Cardiology, Zuckerberg San Francisco General Hospital, and Department of Medicine, University of California, San Francisco, California, USA.
| | - Priscilla Y Hsue
- Division of Cardiology, Zuckerberg San Francisco General Hospital, and Department of Medicine, University of California, San Francisco, California, USA
| |
Collapse
|
18
|
Lin TC, Burton BN, Barleben A, Hoenigl M, Gabriel RA. Association of HIV infection with age and symptomatic carotid atherosclerotic disease at the time of carotid intervention in the United States. Vasc Med 2018; 23:467-475. [PMID: 30101684 DOI: 10.1177/1358863x18789783] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
The primary objectives of this work were: (1) to describe trends in HIV prevalence among those undergoing carotid intervention (carotid endarterectomy or carotid artery stenting) in the United States; and (2) to determine if HIV infection is independently associated with symptomatic carotid atherosclerotic disease or age at the time of carotid intervention. In a nationally representative inpatient database from 2004 to 2014, HIV infection was associated with younger age at the time of carotid intervention (59 years [SE 0.2] vs 71 years [SE 0.01], p < 0.001), male sex (83% vs 58%, p < 0.001), black race (21% vs 4%, p < 0.001), and symptomatic carotid atherosclerotic disease (18.8% vs 11.0%, p < 0.001). Among those undergoing carotid intervention, there was a significant increase in the prevalence of HIV from 0.08% in 2004 to 0.17% in 2014 ( p < 0.001). After adjustment for patient demographics, comorbidities and other covariates, HIV infection remained significantly associated with younger age (-8.9 years; 95% CI: -9.7 to -8.1; p < 0.001) at the time of carotid intervention, but HIV infection was not independently associated with symptomatic carotid atherosclerotic disease.
Collapse
Affiliation(s)
- Timothy C Lin
- 1 UC San Diego School of Medicine, La Jolla, CA, USA
| | | | - Andrew Barleben
- 2 Department of Surgery, Division of Vascular and Endovascular Surgery, UC San Diego, San Diego, CA, USA
| | - Martin Hoenigl
- 3 Department of Medicine, Division of Infectious Diseases and Global Public Health, UC San Diego, San Diego, CA, USA.,4 Section of Infectious Diseases and Tropical Medicine and Division of Pulmonology, Medical University of Graz, Graz, Austria
| | - Rodney A Gabriel
- 5 Department of Anesthesiology, Division of Regional Anesthesia, UC San Diego, San Diego, CA, USA.,6 Department of Medicine, Division of Biomedical Informatics, UC San Diego, San Diego, CA, USA
| |
Collapse
|
19
|
Mosepele M, Molefe-Baikai OJ, Grinspoon SK, Triant VA. Benefits and Risks of Statin Therapy in the HIV-Infected Population. Curr Infect Dis Rep 2018; 20:20. [PMID: 29804227 DOI: 10.1007/s11908-018-0628-7] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
PURPOSE OF REVIEW HIV-infected patients face an increased risk for cardiovascular disease (CVD), estimated at 1.5- to 2-fold as compared to HIV-uninfected persons. This review provides a recent (within preceding 5 years) summary of the role of statin therapy and associated role in CVD risk reduction among HIV-infected patients on anti-retroviral therapy. RECENT FINDINGS Statins remain the preferred agents for reducing risk for CVD among HIV-infected populations based on guidance extrapolated from general population (HIV-uninfected) cholesterol treatment guidelines across different settings globally. However, HIV-infected patients are consistently under prescribed statin therapy when compared to their HIV-uninfected counterparts. The most commonly studied statins in clinical care and small randomized and cohort studies have been rosuvastatin and atorvastatin. Both agents are preferred for their potent lipid-lowering effects and their favorable or neutral pleotropic effects on chronic inflammation, renal function, and hepatic steatosis among others. However, growing experience with the newer glucuronidated pitavastatin suggests that this agent has virtually no adverse drug interactions with ART or effects on glucose metabolism-all marked additional benefits when compared with rosuvastatin and atorvastatin while maintaining comparable anti-lipid effects. Pitavastatin is therefore the statin of choice for the ongoing largest trial (6500 participants) to test the benefits of statin therapy among HIV-infected adults. Statins are underutilized in the prevention of CVD in HIV-infected populations based on criteria in established cholesterol guidelines. There is a potential role for statin therapy for HIV-infected patients who do not meet guideline criteria which will be further delineated through ongoing clinical trials.
Collapse
Affiliation(s)
- Mosepele Mosepele
- Department of Internal Medicine, Faculty of Medicine, University of Botswana, Gaborone, Botswana. .,Botswana-Harvard AIDS Institute Partnership, Gaborone, Botswana. .,Sir Ketumile Masire Teaching Hospital, Faculty of Medicine, University of Botswana, 3rd Floor, Block F, Room F4069, Gaborone, Botswana.
| | | | - Steven K Grinspoon
- Program in Nutritional Metabolism, Harvard Medical School & Massachusetts General Hospital, Boston, MA, USA
| | - Virginia A Triant
- Divisions of Infectious Diseases and General Internal Medicine, Harvard Medical School & Massachusetts General Hospital, Boston, MA, USA
| |
Collapse
|
20
|
Kearns A, Burdo TH, Qin X. Editorial Commentary: Clinical management of cardiovascular disease in HIV-infected patients. Trends Cardiovasc Med 2017; 27:564-566. [PMID: 28774757 DOI: 10.1016/j.tcm.2017.07.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2017] [Accepted: 07/14/2017] [Indexed: 12/12/2022]
Affiliation(s)
- Alison Kearns
- Department of Neuroscience, Lewis Katz School of Medicine at Temple University, Philadelphia, PA
| | - Tricia H Burdo
- Department of Neuroscience, Lewis Katz School of Medicine at Temple University, Philadelphia, PA
| | - Xuebin Qin
- Department of Neuroscience, Lewis Katz School of Medicine at Temple University, Philadelphia, PA.
| |
Collapse
|
21
|
Affiliation(s)
- Steven Grinspoon
- From the Program in Nutritional Metabolism (S.G.) and Cardiac MR PET CT Program (U.H.), Massachusetts General Hospital and Harvard Medical School, Boston
| | - Udo Hoffmann
- From the Program in Nutritional Metabolism (S.G.) and Cardiac MR PET CT Program (U.H.), Massachusetts General Hospital and Harvard Medical School, Boston
| |
Collapse
|