Cardiovascular health among persons with HIV without existing atherosclerotic cardiovascular disease

Abstract

Objectives: We sought to characterize atherosclerotic cardiovascular disease (ASCVD) risk and metrics of CV health in persons with HIV (PWH) eligible for primary prevention of ASCVD. Design: Cross-sectional study of PWH 40 years and older without documented ASCVD who received care at three HIV clinics in San Francisco from 2019-2022. Methods: We used ICD-10 codes and electronic health record data to assess ASCVD risk and CV health, as defined by the American Heart Association's Life's Essential 8 (LE8) metrics for nicotine exposure, body mass index (BMI), lipids, glucose, and blood pressure (BP). Results: Among 2567 PWH eligible for primary prevention of ASCVD, the median age was 55 years, 14% were female, 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 anti-hypertensive. Among those eligible, 43% were prescribed a statin. The mean LE8 CV health score (0 to 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 CV health scores; patients with undetectable viral loads had higher CV health scores. Conclusions: We highlight opportunities for improving primary prevention of ASCVD among PWH, especially in the areas of guideline-based therapy, nicotine exposure, and BP control.

The dynamic risk factors of cardiovascular disease among people living with HIV: a real-world data study

“…Solely reliance on ICD codes to define CVD lacks corroboration from other validation datasets such as the clinical data and medical diagnostic records towards each patient, which would result in the loss of validity and accuracy in relevant conclusions [ 39 ]. Nevertheless, previous literatures demonstrated acceptable or higher sensitivity in solely reliant on ICD codes to define similar variables [ 40 , 41 ]. Therefore, we think the potential misclassification bias of both outcome measure and certain predictors is not substantial.…”

Pitavastatin for cardiovascular health in patients with HIV infection

“…We read with interest the report of Mclaughlin et al [1] titled ‘Cardiovascular health among persons with HIV without existing atherosclerotic cardiovascular disease’ highlighting opportunities for improving primary prevention of atherosclerotic cardiovascular disease in health persons with HIV, especially because a recent trial with pitavastatin showed a positive effect to reduce major adverse cardiovascular events (MACE) in people with HIV infection [2]. Nowadays, thanks to combination antiretroviral therapy (cART), these patients had a good quality of life even if they maintain a high cardiovascular risk [1].…”