In the Journals

Patients with HIV undertreated for cardiovascular events

Joseph A. Ladapo

Patients with HIV infection are less likely to be treated in accordance with guideline-recommended cardiovascular care, as well as receive lifesaving prescriptions for aspirin and statins compared with their counterparts who do not have HIV but are at increased risk, according to data published in the Journal of the American Heart Association.

“Cardiovascular disease is emerging as a major cause of morbidity and mortality among patients with HIV,” Joseph A. Ladapo, MD, PhD, from the David Geffen School of Medicine at University of California, Los Angeles, and colleagues wrote.

“Recent studies have demonstrated that patients with HIV experience approximately a 50% to 100% increased risk of myocardial infarction and stroke compared with HIV-uninfected persons, and they also face higher risks of stroke, sudden death, and heart failure,” they added.

Ladapo and colleagues used data from the 2006 to 2013 National Ambulatory Medical Care Survey/National Hospital Ambulatory Medical Care Survey to compare the use of national guideline-recommended cardiovascular care among a nationally representative sample of patients with and without HIV aged between 40 and 79 years.

The researchers analyzed 1,631 office- or hospital-based visits by patients with HIV and 226,862 visits by patients not infected with HIV, but with cardiovascular risk factors. These visits by patients with HIV represented approximately 2.2 million visits per year in the United States, whereas the visits by patients without HIV represent approximately 602 million visits per year.

The results were adjusted for clinical and demographic factors using logistic regression models with propensity score weighting.

Data indicated that there were more visits by patients without HIV who received aspirin/antiplatelet therapy when they met criteria for primary prevention or had CVD than visits by patients with HIV (13.8% vs. 5.1%). Similarly, more patients without HIV but with diabetes mellitus, CVD or dyslipidemia received a prescription for statin therapy during their visit than HIV-infected patients (34.8% vs. 23.6%).

Among patients with and without HIV, rates of receiving antihypertensive medication therapy (53.4% vs. 58.4%), diet and exercise counseling (14.9% vs. 16.9%) or smoking cessation advice and pharmacotherapy (18.8% vs. 22.4%) did not differ.

“Clinicians work hard to take good care of their patients, but we are not doing enough for CVD prevention in patients with HIV,” Ladapo told Healio Internal Medicine. “A big part of the issue is the epidemiological shift in patients with HIV: they are living longer in wealthy countries like the U.S. and are therefore more likely to develop CVD.”

“This is all a relatively new epidemiological phenomenon because HIV has not been around for that long. Patients with HIV are, of course, not alone in gaps in not always receiving the care that they should. It’s really a national challenge,” he said.

Ladapo noted that EHR-based interventions that provide defaults for treatment such as automatic calculation of CVD risk and automatic prompting for a statin prescription for patients with a significant risk, as well as economic incentives, such as targeted reimbursement for preventive CV care, may help patients with HIV get the care they need.

“There is good evidence for safety and efficacy (reduction in atherosclerotic burden) of statin therapy in patients with HIV,” he said. “Drug interactions are always a concern when patients are on antiretroviral therapy but some statins are safe with low risk of drug interactions (for example, rosuvastatin and pravastatin).” – by Alaina Tedesco

Disclosure: The authors report no relevant financial disclosures.

Joseph A. Ladapo

Patients with HIV infection are less likely to be treated in accordance with guideline-recommended cardiovascular care, as well as receive lifesaving prescriptions for aspirin and statins compared with their counterparts who do not have HIV but are at increased risk, according to data published in the Journal of the American Heart Association.

“Cardiovascular disease is emerging as a major cause of morbidity and mortality among patients with HIV,” Joseph A. Ladapo, MD, PhD, from the David Geffen School of Medicine at University of California, Los Angeles, and colleagues wrote.

“Recent studies have demonstrated that patients with HIV experience approximately a 50% to 100% increased risk of myocardial infarction and stroke compared with HIV-uninfected persons, and they also face higher risks of stroke, sudden death, and heart failure,” they added.

Ladapo and colleagues used data from the 2006 to 2013 National Ambulatory Medical Care Survey/National Hospital Ambulatory Medical Care Survey to compare the use of national guideline-recommended cardiovascular care among a nationally representative sample of patients with and without HIV aged between 40 and 79 years.

The researchers analyzed 1,631 office- or hospital-based visits by patients with HIV and 226,862 visits by patients not infected with HIV, but with cardiovascular risk factors. These visits by patients with HIV represented approximately 2.2 million visits per year in the United States, whereas the visits by patients without HIV represent approximately 602 million visits per year.

The results were adjusted for clinical and demographic factors using logistic regression models with propensity score weighting.

Data indicated that there were more visits by patients without HIV who received aspirin/antiplatelet therapy when they met criteria for primary prevention or had CVD than visits by patients with HIV (13.8% vs. 5.1%). Similarly, more patients without HIV but with diabetes mellitus, CVD or dyslipidemia received a prescription for statin therapy during their visit than HIV-infected patients (34.8% vs. 23.6%).

Among patients with and without HIV, rates of receiving antihypertensive medication therapy (53.4% vs. 58.4%), diet and exercise counseling (14.9% vs. 16.9%) or smoking cessation advice and pharmacotherapy (18.8% vs. 22.4%) did not differ.

“Clinicians work hard to take good care of their patients, but we are not doing enough for CVD prevention in patients with HIV,” Ladapo told Healio Internal Medicine. “A big part of the issue is the epidemiological shift in patients with HIV: they are living longer in wealthy countries like the U.S. and are therefore more likely to develop CVD.”

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“This is all a relatively new epidemiological phenomenon because HIV has not been around for that long. Patients with HIV are, of course, not alone in gaps in not always receiving the care that they should. It’s really a national challenge,” he said.

Ladapo noted that EHR-based interventions that provide defaults for treatment such as automatic calculation of CVD risk and automatic prompting for a statin prescription for patients with a significant risk, as well as economic incentives, such as targeted reimbursement for preventive CV care, may help patients with HIV get the care they need.

“There is good evidence for safety and efficacy (reduction in atherosclerotic burden) of statin therapy in patients with HIV,” he said. “Drug interactions are always a concern when patients are on antiretroviral therapy but some statins are safe with low risk of drug interactions (for example, rosuvastatin and pravastatin).” – by Alaina Tedesco

Disclosure: The authors report no relevant financial disclosures.