Department of Pharmacy Practice and Administrative Sciences, University of New Mexico College of Pharmacy, Albuquerque, NM.
University of New Mexico Truman Health Services, Albuquerque, NM, USA.
Am J Health Syst Pharm. 2022 Nov 7;79(22):2026-2031. doi: 10.1093/ajhp/zxac224.
People with HIV (PWH) are at increased risk for developing atherosclerotic cardiovascular disease (ASCVD). The primary objective of this study was to evaluate adherence to guideline recommendations on statin use in PWH for both primary and secondary ASCVD prevention in a single healthcare institution.
A retrospective chart review was performed to evaluate statin use for cardiovascular risk reduction in PWH 40 to 75 years of age at an HIV clinic over a 1-year evaluation period. The study included patients who met one of the 4 criteria for statin therapy defined in the "ACC/AHA Guideline on the Treatment of Blood Cholesterol to Reduce Atherosclerotic Cardiovascular Risk in Adults." Patient demographics were collected and a 10-year ASCVD risk score was calculated.
A total of 432 PWH were evaluated for statin therapy; 205 patients (47.5%) met criteria for statin therapy. The majority of patients were male, the average age was 58 years, and the average time since HIV diagnosis was 19 years. The mean ASCVD risk score was 14.2%. Only 79 patients (38.5%) who met criteria were prescribed statin therapy, and only 45 (56.9%) were prescribed statin therapy of appropriate intensity. Use of ART pharmacokinetic enhancer was low and did not affect statin prescribing. Multivariable analysis found that age, diabetes, clinical ASCVD, and an appointment with a pharmacist clinician prescriber predicted statin utilization. A high ASCVD risk score (>20%) did not predict statin treatment.
Statin prescribing is low in PWH, who are at increased risk for ASCVD. Future research in PWH should focus on improving ASCVD risk assessment and exploring causes for statin underprescribing.
艾滋病毒（HIV）感染者发生动脉粥样硬化性心血管疾病（ASCVD）的风险增加。本研究的主要目的是评估在单一医疗机构中，HIV 诊所 40 至 75 岁的 HIV 感染者在 ASCVD 一级和二级预防中，遵循他汀类药物使用指南建议的情况。
对在 HIV 诊所进行的为期 1 年的评估期间，40 至 75 岁的 HIV 感染者使用他汀类药物降低心血管风险的情况进行回顾性图表审查。研究纳入符合“美国心脏病学会/美国心脏协会成人降脂治疗降低动脉粥样硬化性心血管疾病风险指南”中他汀类药物治疗 4 项标准之一的患者。收集患者的人口统计学资料，并计算 10 年 ASCVD 风险评分。
共评估了 432 名 HIV 感染者的他汀类药物治疗情况；205 名患者（47.5%）符合他汀类药物治疗标准。大多数患者为男性，平均年龄为 58 岁，HIV 诊断后平均时间为 19 年。平均 ASCVD 风险评分为 14.2%。仅 79 名（38.5%）符合标准的患者开具了他汀类药物治疗处方，仅有 45 名（56.9%）开具了适当强度的他汀类药物治疗处方。ART 药代动力学增强剂的使用较低，并未影响他汀类药物的开具。多变量分析发现，年龄、糖尿病、临床 ASCVD 和与药剂师临床医生预约可预测他汀类药物的使用。高 ASCVD 风险评分（>20%）并不能预测他汀类药物治疗。
HIV 感染者 ASCVD 风险增加，但他汀类药物的开具率较低。未来应在 HIV 感染者中开展研究，重点关注改善 ASCVD 风险评估和探索他汀类药物开具不足的原因。
