Pyarali Fahim, Iordanov Roumen, Ebner Bertrand, Grant Jelani, Vincent Louis, Toirac Alexander, Haque Tahir, Zablah Gerardo, Kapoor Kunal, Powell Alexis, Boulanger Catherine, Hurwitz Barry, Alcaide Maria, Martinez Claudia
Department of Medicine, University of Miami Miller School of Medicine, Miami, FL.
Department of Infectious Diseases, Baylor College of Medicine, Houston, TX.
Medicine (Baltimore). 2021 Jul 16;100(28):e26631. doi: 10.1097/MD.0000000000026631.
Antiretroviral therapy (ART) has improved survival of patients living with HIV (PLWH); however, this has been accompanied by an increase in cardiovascular disease (CVD). Although preventative measures for CVD among the general population are well described, information is limited about CVD prevention among PLWH. The goal of this study was to characterize the prevalence of CVD in our population and to assess the use of primary and secondary prevention.We performed a retrospective review of PLWH receiving primary care at a large academic center in Miami, Florida. We characterized the prevalence of CVD, CVD risk, and the use of aspirin and statins for primary and secondary CVD prevention.A total of 985 charts were reviewed (45% women, 55% men). Average age was 52.2 years. Average CD4 count was 568 cells/microL. 92.9% were receiving ART, and 71% were virologically suppressed. The median 10-year ASCVD risk was 7.3%. The prevalence of CVD was 10.4% (N = 102). The odds of having CVD was lower in patients on ART (OR 0.47, 95% CI: 0.25-0.90, P = .02). The use of medications for primary and secondary prevention of CVD based on current guidelines was low: 15% and 37% for aspirin respectively, and 25% and 44% for statins.CVD risk and rates of CVD are high among PLWH and receiving ART could protect against CVD. However, the use of medications for primary and secondary prevention is low. Increased awareness of CVD risk-reduction strategies is needed among providers of PLWH to decrease the burden of CVD.
抗逆转录病毒疗法(ART)提高了人类免疫缺陷病毒(HIV)感染者(PLWH)的生存率;然而,这一情况伴随着心血管疾病(CVD)发病率的上升。虽然针对普通人群的心血管疾病预防措施已有详尽描述,但关于PLWH心血管疾病预防的信息却很有限。本研究的目的是确定我们所研究人群中心血管疾病的患病率,并评估一级预防和二级预防措施的使用情况。
我们对在佛罗里达州迈阿密的一家大型学术中心接受初级保健的PLWH进行了回顾性研究。我们确定了心血管疾病的患病率、心血管疾病风险,以及阿司匹林和他汀类药物在心血管疾病一级和二级预防中的使用情况。
共审查了985份病历(45%为女性,55%为男性)。平均年龄为52.2岁。平均CD4细胞计数为568个/微升。92.9%的患者正在接受抗逆转录病毒治疗,71%的患者病毒得到抑制。10年动脉粥样硬化性心血管疾病(ASCVD)风险的中位数为7.3%。心血管疾病的患病率为10.4%(N = 102)。接受抗逆转录病毒治疗的患者患心血管疾病的几率较低(比值比0.47,95%置信区间:0.25 - 0.90,P = 0.02)。根据当前指南,用于心血管疾病一级和二级预防的药物使用率较低:阿司匹林的使用率分别为15%和37%,他汀类药物的使用率分别为25%和44%。
PLWH中的心血管疾病风险和发病率较高,接受抗逆转录病毒治疗可能预防心血管疾病。然而,一级和二级预防药物的使用率较低。PLWH的医疗服务提供者需要提高对降低心血管疾病风险策略的认识,以减轻心血管疾病的负担。