Evaluation of Statin Eligibility, Prescribing Practices, and Therapeutic Responses Using ATP III, ACC/AHA, and NLA Dyslipidemia Treatment Guidelines in a Large Urban Cohort of HIV-Infected Outpatients
Year: 2018
Type: article
Abstract: Statin coverage has been examined among HIV-infected patients using Adult Treatment Panel III (ATP III) and American College of Cardiology/American Heart Association (ACC/AHA) guidelines, although not with newer National Lipid Association (NLA) guidelines. We investigated statin eligibility, prescribing practices, and therapeutic responses using these three guidelines. Sociodemographic, clinical, and laboratory data were collected between 2011 and 2016 for HIV-infected outpatients enrolled in the DC Cohort, a multi-center, prospective, observational study in Washington, DC. This analysis included patients aged ≥21 years receiving primary care at their HIV clinic site with ≥1 cholesterol result available. Of 3312 patients (median age 52; 79% black), 52% were eligible for statins based on ≥1 guideline, including 45% (NLA), 40% (ACC/AHA), and 30% (ATP III). Using each guideline, 49% (NLA), 56% (ACC/AHA), and 73% (ATP III) of eligible patients were prescribed statins. Predictors of new prescriptions included older age (aHR = 1.16 [1.08-1.26]/5 years), body mass index ≥30 (aHR = 1.50 [1.07-2.11]), and diabetes (aHR = 1.35 [1.03-1.79]). Hepatitis C coinfection was inversely associated with statin prescriptions (aHR = 0.67 [0.45-1.00]). Among 216 patients with available cholesterol results pre-/post-prescription, 53% achieved their NLA cholesterol goal after 6 months. Hepatitis C coinfection was positively associated (aHR = 1.87 [1.06-3.32]), and depression (aHR = 0.56 [0.35-0.92]) and protease inhibitor use (aHR = 0.61 [0.40-0.93]) were inversely associated, with NLA goal achievement. Half of patients were eligible for statins based on current US guidelines, with the highest proportion eligible based on NLA guidelines, yet, fewer received prescriptions and achieved treatment goals. Greater compliance with recommended statin prescribing practices may reduce cardiovascular disease risk among HIV-infected individuals.
Source: AIDS Patient Care and STDs
Authors: Matthew E. Levy, Alan E. Greenberg, Manya Magnus, Naji Younes, Amanda Castel, Thilakavathy Subramanian, Jeffery Binkley, Rob Taylor, Nabil Rayeed, Cheryl Akridge, Stacey Purinton, Ryan Moog, Jeff Naughton, Lawrence D'Angelo, Natella Rakhmanina, Michael Kharfen, Angela Wood, Princy Kumar, David Parenti, Amanda Castel, Alan Greenberg, Lindsey Powers Happ, Maria Jaurretche, Brittany Lewis, James Peterson, Naji Younes, Ronald Wilcox, Sohail Rana, Michael Horberg, Ricardo Fernandez, Annick Hebou, Carl Dieffenbach, Henry Masur, Jose Bordon, Gebeyehu Teferi, Debra Benator, Maria Elena Ruiz, Deborah Goldstein, David Hardy
Institution: George Washington University
Language: English
Subfield: Surgery
Field: Medicine
Domain: Health Sciences
Open Access status: green
OpenAlex ID: W2785447450