10% of HIV+ Men Who Are Not Taking Statins Should Be
Anne Monroe*1, M Zikusoka1, W Fu2, L Jacobson2, M Witt3, F Palella4, L Kingsley5, W Post1, and T Brown1
1Johns Hopkins Univ Sch of Med, Baltimore, MD, US; 2Johns Hopkins Univ Bloomberg Sch of Publ Hlth, Baltimore, MD, US; 3Los Angeles Biomed Res Inst at Harbor UCLA Med Ctr, Torrance, CA, US; 4Northwestern Univ, Feinberg Sch of Med, Chicago, IL, US; and 5Univ of Pittsburgh Grad Sch of Pub Hlth, PA, US
Background: Cardiovascular disease (CVD) risk reduction, in part through optimization of low-density lipoprotein (LDL), is a priority in HIV care. The use of statins to meet current National Cholesterol Education Program Adult Treatment Plan III (NCEP ATP III) LDL guidelines reduces CVD events and mortality in the general population. We studied men not taking statin therapy and determined what proportion should be taking statins based on current LDL level and calculated LDL goal. We hypothesized that HIV+ men would be more likely not to be taking indicated statins.
Methods: We performed a preliminary cross-sectional analysis using Multicenter AIDS Cohort Study (MACS) data. We included HIV+ and HIV– men who have sex with men (MSM) not on statins (self-report, standardized questionnaire). Using questionnaire data, we assessed coronary heart disease equivalents and Framingham Risk Score (FRS) as described in NCEP ATP III to determine each participant’s LDL goal. LDL measurement was collected at a routine lab draw. Participants’ statin nonuse was classified as “inappropriate” (not taking statins, not at LDL goal) or “appropriate” (not taking statins, at LDL goal). Pearson Chi-square analysis was used to compare the proportion of inappropriate statin nonuse by HIV status.
Results: 663 HIV+ participants and 699 HIV– participants not on statins were included in the analysis. 9.8% of HIV+ men not on statins were not at LDL goal and 15.5% of HIV– men not on statins were not at LDL goal (p = 0.02). HIV+ participants were younger (51 v 55 years, p <0.0001), less likely to be African American (64.6 v 80.8%, p <0.0001), more likely to be currently smoking (30.8 vs 21.5%, p <0.0001), and more likely to have a high-density lipoprotein (HDL) <40 mg/dL (33.6 vs 18.2%, p <0.0001). Median unadjusted LDL was 109 and 120 mg/dL in HIV+ and HIV– men, respectively (p <0.0001). Median FRS was 6% in HIV+ men and 8% in HIV– men (p <0.0001).
Conclusions: 10% of the HIV+ men in this sample not taking statins should be, compared with 16% of the HIV– men, who were slightly older and had a higher FRS. Given the potential for increased CVD risk in HIV+ men, providers should be vigilant in assessing LDL and treating when LDL exceeds the target. However, these data suggest that men with HIV are not being undertreated with statin therapy compared with men without HIV.