Pan Meng, Agovi Afiba Manza-A, Anikpo Ifedioranma O, Fasanmi Esther O, Thompson Erika L, Reeves Jaquetta M, Thompson Caitlin T, Johnson Marc E, Golub Vitaly, Ojha Rohit P
Center for Epidemiology & Healthcare Delivery Research, JPS Health Network, Fort Worth, TX, USA.
Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, USA.
Prev Med Rep. 2023 Mar 16;33:102175. doi: 10.1016/j.pmedr.2023.102175. eCollection 2023 Jun.
The American College of Cardiology (ACC)/American Heart Association (AHA) guidelines were updated in 2018 to explicitly recommend statin use for primary cardiovascular disease prevention among people living with HIV (PLWH), but little is known about the effect of this guideline change. We aimed to assess the effect of the 2018 ACC/AHA guideline change on statin prescription among PLWH. We used data from an institutional HIV registry to identify PLWH aged 40-75 years, engaged in HIV care between June 2016 and May 2021, had a LDL cholesterol between 70 and 189 mg/dl, 10-year atherosclerotic cardiovascular disease (ASCVD) risk score ≥7.5%, no prior statin prescription, and no history of diabetes or ASCVD. Our outcome of interest was a new statin prescription within 12 months of eligibility. We estimated standardized risk difference (RD) with 95% confidence limits (CL) by comparing prescription probabilities before and after guideline change. Our study population comprised 251 PLWH (171 before, 80 after the guideline change), of whom 57% were aged <55 years, 82% were male, and 45% were non-Hispanic black. The standardized 12-month statin prescription risk was 43% (95% CL: 31%, 60%) after the guideline change and 19% (95% CL: 13%, 26%) before the guideline change (RD = 25%, 95% CL: 9.1%, 40%). Our results suggest that the 2018 ACC/AHA guideline change increased statin prescription among PLWH, but a sizable proportion of eligible PLWH were not prescribed statin. Future studies are needed to identify strategies to enhance implementation of statin prescription guidelines among PLWH.
美国心脏病学会（ACC）/美国心脏协会（AHA）指南于2018年更新，明确建议对感染HIV的人（PLWH）使用他汀类药物进行原发性心血管疾病预防，但对于这一指南变化的影响知之甚少。我们旨在评估2018年ACC/AHA指南变化对PLWH他汀类药物处方的影响。我们使用机构HIV登记处的数据，确定年龄在40 - 75岁之间、在2016年6月至2021年5月期间接受HIV治疗、低密度脂蛋白胆固醇在70至189mg/dl之间、10年动脉粥样硬化性心血管疾病（ASCVD）风险评分≥7.5%、既往未使用过他汀类药物处方且无糖尿病或ASCVD病史的PLWH。我们感兴趣的结局是符合条件后12个月内开具新的他汀类药物处方。通过比较指南变化前后的处方概率，我们估计了标准化风险差异（RD）及其95%置信区间（CL）。我们的研究人群包括251名PLWH（指南变化前171名，变化后80名），其中57%年龄<55岁，82%为男性，45%为非西班牙裔黑人。指南变化后标准化的12个月他汀类药物处方风险为43%（95%CL：31%，60%），指南变化前为19%（95%CL：13%，26%）（RD = 25%，95%CL：9.1%，40%）。我们的结果表明，2018年ACC/AHA指南变化增加了PLWH中他汀类药物的处方，但仍有相当比例符合条件的PLWH未开具他汀类药物。未来需要开展研究以确定提高PLWH中他汀类药物处方指南实施率的策略。
