338. Patients Living with HIV Infection Are Less Likely to Receive the Correct Intensity of Statin Therapy for Cardiovascular Disease Risk Reduction

Abstract

BackgroundPatients living with HIV (PLWH) at risk for atherosclerotic cardiovascular disease (ASCVD) should receive risk reduction interventions recommended in current guidelines. This includes routine ASCVD risk assessments and when eligible, statins selected and dosed to achieve appropriate low-density lipoprotein cholesterol (LDL-C) reduction. Recent studies suggest that statins are underprescribed in PLWH, but none have assessed if eligible patients receive the correct statin intensity compared with uninfected controls.MethodsThis retrospective study evaluated statin eligibility and prescribing among consecutive patients in an HIV clinic and an internal medicine clinic at an urban, academic medical center from June-September 2018. To determine statin eligibility, the 2013 American College of Cardiology/American Heart Association guideline on treating blood cholesterol to reduce ASCVD risk was used. Patients aged 40–75 that had a lipid panel obtained within the last year were included. All patients were assessed to determine eligibility for and actual treatment with appropriate statin therapy. Characteristics of patients correctly and incorrectly treated with statins were compared with chi-square testing and predictors for receiving correct statin therapy were determined with logistic multivariable regression.ResultsA total of 221/300 study subjects were statin eligible (Table 1). While many eligible PLWH were receiving a statin (54/106), considerably fewer were on the correct statin intensity for their benefit group (33/106). In the univariate analysis (Table 2), correctly treated patients were less likely to be PLWH or female, and were more likely to have polypharmacy and hypertension. In the multivariable logistic regression analysis (Table 3), PLWH (OR 0.26, CI95 0.12–0.57)) were significantly less likely to receive correct statin therapy, while those with concomitant polypharmacy were significantly more likely to receive correct statin therapy (OR 5.52, CI95 1.94, 15.69).ConclusionThis study reveals that PLWH may be at a substantial disadvantage in terms of receiving correct statin therapy for ASCVD risk reduction. This finding may be particularly important given the heightened risk for ASCVD in this patient population. Disclosures All authors: No reported disclosures.

Retrospective cohort study of statin prescribing for primary prevention among people living with HIV

“…18 Previous studies evaluating statin prescribing rates for various indications in PLWH reported ranges from 42%-72%. [10][11][12][13] One cohort study of more than 3,000 PLWH in Washington, D.C. found that 52% of patients were eligible for statin therapy for primary or secondary prevention according to at least one cholesterol guideline. 10 Among this group, 49%-73% of eligible patients were prescribed statins depending on the cholesterol guideline utilized.…”

“…These studies included patient populations with all statin indications beyond just primary prevention, such as clinical ASCVD, diabetes, and severe hypercholesteremia. [10][11][12][13] By limiting the inclusion and exclusion criteria, our study uniquely evaluated the role of HIV as a riskenhancing factor use of statin therapy in intermediate-risk patients. This study has a few limitations.…”

“…Within these cohort studies of PLWH, rates of eligible patients receiving statins ranged from 42% to 73%. [10][11][12][13] Our study compared statin prescribing rates at Denver Health between intermediate-risk PLWH and intermediate-risk patients without a diagnosis of HIV.…”