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Larson D, Won SH, Ganesan A, Maves RC, Kronmann K, Okulicz JF, Chu X, Schofield C, O’Bryan T, Agan BK, Deiss R. Statin usage and cardiovascular risk among people living with HIV in the U.S. Military HIV Natural History Study. HIV Med 2022; 23:249-258. [PMID: 34704330 PMCID: PMC8847313 DOI: 10.1111/hiv.13195] [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: 09/08/2021] [Revised: 10/04/2021] [Accepted: 10/06/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Using the American College of Cardiology/American Heart Association 2013 atherosclerotic cardiovascular disease (ASCVD) management guidelines, we conducted a retrospective cross-sectional analysis of people living with HIV in the US Military HIV Natural History Study to determine whether individuals were receiving statins when indicated. METHODS Prescription data was taken from Military Health System data. Statin eligibility was defined by ASCVD guidelines. We used the 10-year ASCVD pooled cohorts' equation to evaluate risk for each participant. RESULTS Across all categories, 31.9% (n = 390) of individuals met criteria for statin use, and when adding these subjects to the number of those already receiving statins (n = 96), 62.1% of all eligible subjects (n = 302/486) were actually receiving statin therapy. In multivariable analysis, individuals of African American race [odds ratio (OR) = 0.48, 95% confidence interval (CI): 0.31-0.73] or Hispanic ethnicity (OR = 0.42, 95% CI: 0.19-0.94) were less likely to receive statin prescriptions than white individuals. Individuals with a higher CD4 count (OR = 1.12, 95% CI: 1.05-1.20 per 100 cells/μL]) were significantly more likely to receive a statin prescription. CONCLUSIONS These data highlight discrepancies between ASCVD guidelines and primary care management of people living with HIV (PLWH) in the military health system, along with important racial differences. Targeted interventions are critical to identify and treat appropriate candidates for statin therapy among PLWH in the military and other settings.
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Affiliation(s)
- Derek Larson
- Fort Belvoir Community Hospital, Fort Belvoir, VA,Infectious Disease Clinical Research Program, Uniformed
Services University of the Health Sciences, Bethesda, MD
| | - Seung Hyun Won
- Infectious Disease Clinical Research Program, Uniformed
Services University of the Health Sciences, Bethesda, MD,The Henry M. Jackson Foundation for the Advancement of
Military Medicine, Inc, Bethesda, MD
| | - Anuradha Ganesan
- Infectious Disease Clinical Research Program, Uniformed
Services University of the Health Sciences, Bethesda, MD,The Henry M. Jackson Foundation for the Advancement of
Military Medicine, Inc, Bethesda, MD,Walter Reed National Military Medical Center, Bethesda,
MD
| | - Ryan C. Maves
- Infectious Disease Clinical Research Program, Uniformed
Services University of the Health Sciences, Bethesda, MD,Naval Medical Center San Diego, San Diego, CA
| | | | - Jason F. Okulicz
- Infectious Disease Service, Brooke Army Medical Center, San
Antonio, Texas
| | - Xiuping Chu
- Infectious Disease Clinical Research Program, Uniformed
Services University of the Health Sciences, Bethesda, MD,The Henry M. Jackson Foundation for the Advancement of
Military Medicine, Inc, Bethesda, MD
| | | | - Thomas O’Bryan
- Infectious Disease Clinical Research Program, Uniformed
Services University of the Health Sciences, Bethesda, MD,The Henry M. Jackson Foundation for the Advancement of
Military Medicine, Inc, Bethesda, MD,Infectious Disease Service, Brooke Army Medical Center, San
Antonio, Texas
| | - Brian K. Agan
- Infectious Disease Clinical Research Program, Uniformed
Services University of the Health Sciences, Bethesda, MD,The Henry M. Jackson Foundation for the Advancement of
Military Medicine, Inc, Bethesda, MD
| | - Robert Deiss
- University of California, San Diego, La Jolla, CA
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10
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Gupta P, Patel P, Štrauch B, Lai FY, Akbarov A, Marešová V, White CM, Petrák O, Gulsin GS, Patel V, Rosa J, Cole R, Zelinka T, Holaj R, Kinnell A, Smith PR, Thompson JR, Squire I, Widimský J, Samani NJ, Williams B, Tomaszewski M. Risk Factors for Nonadherence to Antihypertensive Treatment. Hypertension 2017; 69:1113-1120. [DOI: 10.1161/hypertensionaha.116.08729] [Citation(s) in RCA: 118] [Impact Index Per Article: 16.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2016] [Revised: 11/28/2016] [Accepted: 03/01/2017] [Indexed: 01/06/2023]
Abstract
Nonadherence to antihypertensive treatment is a critical contributor to suboptimal blood pressure control. There are limited and heterogeneous data on the risk factors for nonadherence because few studies used objective-direct diagnostic methods. We used high-performance liquid chromatography-tandem mass spectrometry of urine and serum to detect nonadherence and explored its association with the main demographic- and therapy-related factors in 1348 patients with hypertension from 2 European countries. The rates of nonadherence to antihypertensive treatment were 41.6% and 31.5% in the UK and Czech populations, respectively. Nonadherence was inversely related to age and male sex. Each increase in the number of antihypertensive medications led to 85% and 77% increase in nonadherence (
P
<0.001) in the UK and Czech populations, respectively. The odds of nonadherence to diuretics were the highest among 5 classes of antihypertensive medications (
P
≤0.005 in both populations). The predictive model for nonadherence, including age, sex, diuretics, and the number of prescribed antihypertensives, showed area under the curves of 0.758 and 0.710 in the UK and Czech populations, respectively. The area under the curves for the UK model tested on the Czech data and for the Czech model tested on UK data were calculated at 0.708 and 0.756, respectively. We demonstrate that the number and class of prescribed antihypertensives are modifiable risk factors for biochemically confirmed nonadherence to blood pressure–lowering therapy. Further development of discriminatory models incorporating these parameters might prove clinically useful in assessment of nonadherence in countries where biochemical analysis is unavailable.
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Affiliation(s)
- Pankaj Gupta
- From the Department of Metabolic Medicine and Chemical Pathology, University Hospitals of Leicester NHS Trust, United Kingdom (P.G., P.P., R.C., A.K., P.R.S.); National Institute of Health Research, Leicester Cardiovascular Biomedical Research Unit, Glenfield Hospital, United Kingdom (P.G., P.P., F.Y.L., G.S.G., I.S., N.J.S.); Department of Cardiovascular Sciences, British Heart Foundation Cardiovascular Research Centre (P.G., P.P., F.Y.L., C.M.J.W., G.S.G., I.S., N.J.S.) and Department of Health
| | - Prashanth Patel
- From the Department of Metabolic Medicine and Chemical Pathology, University Hospitals of Leicester NHS Trust, United Kingdom (P.G., P.P., R.C., A.K., P.R.S.); National Institute of Health Research, Leicester Cardiovascular Biomedical Research Unit, Glenfield Hospital, United Kingdom (P.G., P.P., F.Y.L., G.S.G., I.S., N.J.S.); Department of Cardiovascular Sciences, British Heart Foundation Cardiovascular Research Centre (P.G., P.P., F.Y.L., C.M.J.W., G.S.G., I.S., N.J.S.) and Department of Health
| | - Branislav Štrauch
- From the Department of Metabolic Medicine and Chemical Pathology, University Hospitals of Leicester NHS Trust, United Kingdom (P.G., P.P., R.C., A.K., P.R.S.); National Institute of Health Research, Leicester Cardiovascular Biomedical Research Unit, Glenfield Hospital, United Kingdom (P.G., P.P., F.Y.L., G.S.G., I.S., N.J.S.); Department of Cardiovascular Sciences, British Heart Foundation Cardiovascular Research Centre (P.G., P.P., F.Y.L., C.M.J.W., G.S.G., I.S., N.J.S.) and Department of Health
| | - Florence Y. Lai
- From the Department of Metabolic Medicine and Chemical Pathology, University Hospitals of Leicester NHS Trust, United Kingdom (P.G., P.P., R.C., A.K., P.R.S.); National Institute of Health Research, Leicester Cardiovascular Biomedical Research Unit, Glenfield Hospital, United Kingdom (P.G., P.P., F.Y.L., G.S.G., I.S., N.J.S.); Department of Cardiovascular Sciences, British Heart Foundation Cardiovascular Research Centre (P.G., P.P., F.Y.L., C.M.J.W., G.S.G., I.S., N.J.S.) and Department of Health
| | - Artur Akbarov
- From the Department of Metabolic Medicine and Chemical Pathology, University Hospitals of Leicester NHS Trust, United Kingdom (P.G., P.P., R.C., A.K., P.R.S.); National Institute of Health Research, Leicester Cardiovascular Biomedical Research Unit, Glenfield Hospital, United Kingdom (P.G., P.P., F.Y.L., G.S.G., I.S., N.J.S.); Department of Cardiovascular Sciences, British Heart Foundation Cardiovascular Research Centre (P.G., P.P., F.Y.L., C.M.J.W., G.S.G., I.S., N.J.S.) and Department of Health
| | - Věra Marešová
- From the Department of Metabolic Medicine and Chemical Pathology, University Hospitals of Leicester NHS Trust, United Kingdom (P.G., P.P., R.C., A.K., P.R.S.); National Institute of Health Research, Leicester Cardiovascular Biomedical Research Unit, Glenfield Hospital, United Kingdom (P.G., P.P., F.Y.L., G.S.G., I.S., N.J.S.); Department of Cardiovascular Sciences, British Heart Foundation Cardiovascular Research Centre (P.G., P.P., F.Y.L., C.M.J.W., G.S.G., I.S., N.J.S.) and Department of Health
| | - Christobelle M.J. White
- From the Department of Metabolic Medicine and Chemical Pathology, University Hospitals of Leicester NHS Trust, United Kingdom (P.G., P.P., R.C., A.K., P.R.S.); National Institute of Health Research, Leicester Cardiovascular Biomedical Research Unit, Glenfield Hospital, United Kingdom (P.G., P.P., F.Y.L., G.S.G., I.S., N.J.S.); Department of Cardiovascular Sciences, British Heart Foundation Cardiovascular Research Centre (P.G., P.P., F.Y.L., C.M.J.W., G.S.G., I.S., N.J.S.) and Department of Health
| | - Ondřej Petrák
- From the Department of Metabolic Medicine and Chemical Pathology, University Hospitals of Leicester NHS Trust, United Kingdom (P.G., P.P., R.C., A.K., P.R.S.); National Institute of Health Research, Leicester Cardiovascular Biomedical Research Unit, Glenfield Hospital, United Kingdom (P.G., P.P., F.Y.L., G.S.G., I.S., N.J.S.); Department of Cardiovascular Sciences, British Heart Foundation Cardiovascular Research Centre (P.G., P.P., F.Y.L., C.M.J.W., G.S.G., I.S., N.J.S.) and Department of Health
| | - Gaurav S. Gulsin
- From the Department of Metabolic Medicine and Chemical Pathology, University Hospitals of Leicester NHS Trust, United Kingdom (P.G., P.P., R.C., A.K., P.R.S.); National Institute of Health Research, Leicester Cardiovascular Biomedical Research Unit, Glenfield Hospital, United Kingdom (P.G., P.P., F.Y.L., G.S.G., I.S., N.J.S.); Department of Cardiovascular Sciences, British Heart Foundation Cardiovascular Research Centre (P.G., P.P., F.Y.L., C.M.J.W., G.S.G., I.S., N.J.S.) and Department of Health
| | - Veena Patel
- From the Department of Metabolic Medicine and Chemical Pathology, University Hospitals of Leicester NHS Trust, United Kingdom (P.G., P.P., R.C., A.K., P.R.S.); National Institute of Health Research, Leicester Cardiovascular Biomedical Research Unit, Glenfield Hospital, United Kingdom (P.G., P.P., F.Y.L., G.S.G., I.S., N.J.S.); Department of Cardiovascular Sciences, British Heart Foundation Cardiovascular Research Centre (P.G., P.P., F.Y.L., C.M.J.W., G.S.G., I.S., N.J.S.) and Department of Health
| | - Ján Rosa
- From the Department of Metabolic Medicine and Chemical Pathology, University Hospitals of Leicester NHS Trust, United Kingdom (P.G., P.P., R.C., A.K., P.R.S.); National Institute of Health Research, Leicester Cardiovascular Biomedical Research Unit, Glenfield Hospital, United Kingdom (P.G., P.P., F.Y.L., G.S.G., I.S., N.J.S.); Department of Cardiovascular Sciences, British Heart Foundation Cardiovascular Research Centre (P.G., P.P., F.Y.L., C.M.J.W., G.S.G., I.S., N.J.S.) and Department of Health
| | - Richard Cole
- From the Department of Metabolic Medicine and Chemical Pathology, University Hospitals of Leicester NHS Trust, United Kingdom (P.G., P.P., R.C., A.K., P.R.S.); National Institute of Health Research, Leicester Cardiovascular Biomedical Research Unit, Glenfield Hospital, United Kingdom (P.G., P.P., F.Y.L., G.S.G., I.S., N.J.S.); Department of Cardiovascular Sciences, British Heart Foundation Cardiovascular Research Centre (P.G., P.P., F.Y.L., C.M.J.W., G.S.G., I.S., N.J.S.) and Department of Health
| | - Tomáš Zelinka
- From the Department of Metabolic Medicine and Chemical Pathology, University Hospitals of Leicester NHS Trust, United Kingdom (P.G., P.P., R.C., A.K., P.R.S.); National Institute of Health Research, Leicester Cardiovascular Biomedical Research Unit, Glenfield Hospital, United Kingdom (P.G., P.P., F.Y.L., G.S.G., I.S., N.J.S.); Department of Cardiovascular Sciences, British Heart Foundation Cardiovascular Research Centre (P.G., P.P., F.Y.L., C.M.J.W., G.S.G., I.S., N.J.S.) and Department of Health
| | - Robert Holaj
- From the Department of Metabolic Medicine and Chemical Pathology, University Hospitals of Leicester NHS Trust, United Kingdom (P.G., P.P., R.C., A.K., P.R.S.); National Institute of Health Research, Leicester Cardiovascular Biomedical Research Unit, Glenfield Hospital, United Kingdom (P.G., P.P., F.Y.L., G.S.G., I.S., N.J.S.); Department of Cardiovascular Sciences, British Heart Foundation Cardiovascular Research Centre (P.G., P.P., F.Y.L., C.M.J.W., G.S.G., I.S., N.J.S.) and Department of Health
| | - Angela Kinnell
- From the Department of Metabolic Medicine and Chemical Pathology, University Hospitals of Leicester NHS Trust, United Kingdom (P.G., P.P., R.C., A.K., P.R.S.); National Institute of Health Research, Leicester Cardiovascular Biomedical Research Unit, Glenfield Hospital, United Kingdom (P.G., P.P., F.Y.L., G.S.G., I.S., N.J.S.); Department of Cardiovascular Sciences, British Heart Foundation Cardiovascular Research Centre (P.G., P.P., F.Y.L., C.M.J.W., G.S.G., I.S., N.J.S.) and Department of Health
| | - Paul R. Smith
- From the Department of Metabolic Medicine and Chemical Pathology, University Hospitals of Leicester NHS Trust, United Kingdom (P.G., P.P., R.C., A.K., P.R.S.); National Institute of Health Research, Leicester Cardiovascular Biomedical Research Unit, Glenfield Hospital, United Kingdom (P.G., P.P., F.Y.L., G.S.G., I.S., N.J.S.); Department of Cardiovascular Sciences, British Heart Foundation Cardiovascular Research Centre (P.G., P.P., F.Y.L., C.M.J.W., G.S.G., I.S., N.J.S.) and Department of Health
| | - John R. Thompson
- From the Department of Metabolic Medicine and Chemical Pathology, University Hospitals of Leicester NHS Trust, United Kingdom (P.G., P.P., R.C., A.K., P.R.S.); National Institute of Health Research, Leicester Cardiovascular Biomedical Research Unit, Glenfield Hospital, United Kingdom (P.G., P.P., F.Y.L., G.S.G., I.S., N.J.S.); Department of Cardiovascular Sciences, British Heart Foundation Cardiovascular Research Centre (P.G., P.P., F.Y.L., C.M.J.W., G.S.G., I.S., N.J.S.) and Department of Health
| | - Iain Squire
- From the Department of Metabolic Medicine and Chemical Pathology, University Hospitals of Leicester NHS Trust, United Kingdom (P.G., P.P., R.C., A.K., P.R.S.); National Institute of Health Research, Leicester Cardiovascular Biomedical Research Unit, Glenfield Hospital, United Kingdom (P.G., P.P., F.Y.L., G.S.G., I.S., N.J.S.); Department of Cardiovascular Sciences, British Heart Foundation Cardiovascular Research Centre (P.G., P.P., F.Y.L., C.M.J.W., G.S.G., I.S., N.J.S.) and Department of Health
| | - Jiří Widimský
- From the Department of Metabolic Medicine and Chemical Pathology, University Hospitals of Leicester NHS Trust, United Kingdom (P.G., P.P., R.C., A.K., P.R.S.); National Institute of Health Research, Leicester Cardiovascular Biomedical Research Unit, Glenfield Hospital, United Kingdom (P.G., P.P., F.Y.L., G.S.G., I.S., N.J.S.); Department of Cardiovascular Sciences, British Heart Foundation Cardiovascular Research Centre (P.G., P.P., F.Y.L., C.M.J.W., G.S.G., I.S., N.J.S.) and Department of Health
| | - Nilesh J. Samani
- From the Department of Metabolic Medicine and Chemical Pathology, University Hospitals of Leicester NHS Trust, United Kingdom (P.G., P.P., R.C., A.K., P.R.S.); National Institute of Health Research, Leicester Cardiovascular Biomedical Research Unit, Glenfield Hospital, United Kingdom (P.G., P.P., F.Y.L., G.S.G., I.S., N.J.S.); Department of Cardiovascular Sciences, British Heart Foundation Cardiovascular Research Centre (P.G., P.P., F.Y.L., C.M.J.W., G.S.G., I.S., N.J.S.) and Department of Health
| | - Bryan Williams
- From the Department of Metabolic Medicine and Chemical Pathology, University Hospitals of Leicester NHS Trust, United Kingdom (P.G., P.P., R.C., A.K., P.R.S.); National Institute of Health Research, Leicester Cardiovascular Biomedical Research Unit, Glenfield Hospital, United Kingdom (P.G., P.P., F.Y.L., G.S.G., I.S., N.J.S.); Department of Cardiovascular Sciences, British Heart Foundation Cardiovascular Research Centre (P.G., P.P., F.Y.L., C.M.J.W., G.S.G., I.S., N.J.S.) and Department of Health
| | - Maciej Tomaszewski
- From the Department of Metabolic Medicine and Chemical Pathology, University Hospitals of Leicester NHS Trust, United Kingdom (P.G., P.P., R.C., A.K., P.R.S.); National Institute of Health Research, Leicester Cardiovascular Biomedical Research Unit, Glenfield Hospital, United Kingdom (P.G., P.P., F.Y.L., G.S.G., I.S., N.J.S.); Department of Cardiovascular Sciences, British Heart Foundation Cardiovascular Research Centre (P.G., P.P., F.Y.L., C.M.J.W., G.S.G., I.S., N.J.S.) and Department of Health
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