US Statin Guidelines May Not Be Appropriate for People With HIV
Statin guidelines
American College of Cardiology/American Heart Association (ACC/AHA) cholesterol guidelines issued in 2013 would not recommend statin therapy for almost three quarters of HIV-positive people with subclinical high-risk coronary plaques, according to results of a 108-person analysis in Boston.
People with HIV infection run a higher risk of cardiovascular disease than people in the general population. Computed tomography angiography studies by the Boston researchers found that many HIV-positive people without cardiovascular symptoms have high-risk coronary plaques. Because 2013 ACC/AHA cholesterol guidelines have not been validated in people with HIV, the Boston team compared 2013 guidelines and 2004 Adult Treatment Panel III guidelines in an HIV group.
The study involved 108 HIV-positive people without cardiovascular disease and not taking lipid-lowering therapy. All had contrast-enhanced computed tomography angiography to look for high-risk coronary artery plaques.
For all study participants, 10-year atherosclerotic cardiovascular disease risk was 3.3%, but 36% of participants had high-risk coronary plaques.
Among people with high-risk plaques, the 2013 guidelines would recommend statins for only 26%, while the 2004 guidelines would recommend statins for only 10% (P = 0.04). Among people without high-risk plaques, the 2013 guidelines would recommend statins for 19%, while the 2004 guidelines would recommend statins for 7% (P = 0.005).
Multivariate modeling verified a significant association between 10-year atherosclerotic cardiovascular disease risk score and high-risk coronary plaques (P = 0.02), but other factors not included in the 2013 guidelines were also associated with high-risk plaques.
The researchers conclude that 2013 ACC/AHA cholesterol guidelines recommend statins for a higher proportion of HIV-positive people with and without high-risk coronary artery plaques than did 2004 guidelines. Yet even the 2013 guidelines would not recommend statins for 74% of HIV-positive people with subclinical coronary artery plaques.
The authors call for "outcome studies . . . to determine the utility of new statin recommendations and the contribution of high-risk morphology coronary plaque to cardiovascular disease events among HIV-infected subjects."
Source: Markella V. Zanni, Kathleen V. Fitch, Meghan Feldpausch, Allison Han, Hang Lee, Michael T. Lu, Suhny Abbara, Heather Ribaudo, Pamela S. Douglas, Udo Hoffmann, Janet Lo, Steven K. Grinspoon. 2013 American College of Cardiology/American Heart Association and 2004 Adult Treatment Panel III cholesterol guidelines applied to HIV-infected patients with/without subclinical high-risk coronary plaque. AIDS. 2014; 28: 2061-2070.
Written by Mark Mascolini on behalf of the International AIDS Society