Division of Cardiology, Department of Medicine, University of California San Francisco.
Division of Cardiology, Department of Medicine, Zuckerberg San Francisco General Hospital.
AIDS. 2023 Nov 15;37(14):2179-2183. doi: 10.1097/QAD.0000000000003666. Epub 2023 Jul 26.
We sought to characterize atherosclerotic cardiovascular disease (ASCVD) risk and metrics of cardiovascular health in persons with HIV (PWH) eligible for primary prevention of ASCVD.
A cross-sectional study of PWH 40 years and older without documented ASCVD who received care at three HIV clinics in San Francisco from 2019 to 2022.
We used ICD-10 codes and electronic health record data to assess ASCVD risk and cardiovascular health, as defined by the American Heart Association's Life's Essential 8 (LE8) metrics for nicotine exposure, BMI, lipids, glucose, and blood pressure (BP).
Among 2567 PWH eligible for primary prevention of ASCVD, the median age was 55 years, 14% were women, and 95% were on antiretroviral therapy. Seventy-seven percent had undergone complete assessment of ASCVD risk factors, and 50% of these patients had intermediate-high ASCVD risk (≥7.5%). Of those with hypertension, 39% were prescribed an antihypertensive. Among those eligible, 43% were prescribed a statin. The mean LE8 cardiovascular health score [0--100 (best health)] was 55.1 for nicotine exposure, 71.3 for BMI, 70.4 for lipids, 81.2 for blood glucose, 56.0 for BP, with an average score of 66.2 across the five metrics. Patients with Medicare insurance, black patients, and those with sleep apnea and chronic kidney disease had on average lower cardiovascular health scores; patients with undetectable viral loads had higher cardiovascular health scores.
We highlight opportunities for improving primary prevention of ASCVD among PWH, especially in the areas of guideline-based therapy, nicotine exposure, and BP control.
我们旨在描述有资格进行 ASCVD 一级预防的 HIV 感染者（PWH）的 ASCVD 风险特征和心血管健康指标。
这是一项在旧金山的三个 HIV 诊所接受治疗、年龄在 40 岁及以上且无 ASCVD 记录的 PWH 中开展的横断面研究，研究时间为 2019 年至 2022 年。
我们使用 ICD-10 编码和电子健康记录数据来评估 ASCVD 风险和心血管健康，心血管健康由美国心脏协会的生命基本 8（LE8）指标定义，这些指标包括尼古丁暴露、BMI、血脂、血糖和血压（BP）。
在 2567 名有资格进行 ASCVD 一级预防的 PWH 中，中位年龄为 55 岁，14%为女性，95%正在接受抗逆转录病毒治疗。77%接受了 ASCVD 危险因素的全面评估，其中 50%的患者具有中高危 ASCVD 风险（≥7.5%）。在患有高血压的患者中，39%接受了降压治疗。在符合条件的患者中，43%接受了他汀类药物治疗。LE8 心血管健康评分（0-100，最佳健康）的平均值为尼古丁暴露 55.1，BMI 71.3，血脂 70.4，血糖 81.2，BP 56.0，五个指标的平均得分为 66.2。有医疗保险、黑人患者以及患有睡眠呼吸暂停和慢性肾脏病的患者平均心血管健康评分较低；病毒载量不可检测的患者心血管健康评分较高。
我们强调了在 PWH 中改善 ASCVD 一级预防的机会，特别是在基于指南的治疗、尼古丁暴露和 BP 控制方面。
