Statin Use With the ATP III Guidelines Compared to the 2013 ACC/AHA Guidelines in HIV Primary Care Patients

Elsamadisi, Pansy; Cha, Agnes; Kim, Elise; Latif, Safia

doi:10.1177/0897190015611774

Cited by 7 publications

(8 citation statements)

References 11 publications

(7 reference statements)

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“…The higher proportion with an indication for statin therapy by ASCVD relative to FRS guidelines has also been reported among other HIV patient populations [ 19 , 20 ]. Yet, there was high agreement between ASCVD and FRS in our cohort as has been reported in other small clinical HIV-cohorts [ 21 ]. Thus, the choice of tool is much less relevant than implementation of screening in general.…”

Section: Discussionsupporting

confidence: 87%

Cholesterol Screening and Statin Prescription is Low Among HIV-Infected Patients on Protease-Inhibitor Regimens in Botswana

Mosepele¹,

Letsatsi²,

Mokgatlhe³

et al. 2017

TOAIDJ

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Section: Discussionsupporting

confidence: 87%

Cholesterol Screening and Statin Prescription is Low Among HIV-Infected Patients on Protease-Inhibitor Regimens in Botswana

Mosepele¹,

Letsatsi²,

Mokgatlhe³

et al. 2017

TOAIDJ

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“…These prescribing outcomes in team‐based care are much higher than previously described. Three studies observed a rate of 49% to 56% of HIV‐infected patients prescribed statin therapy when indicated and 56% prescribed appropriate statin intensity . Frieberg and colleagues reported that 36% of PLWH with CHD or CHD equivalents did not receive statin therapy; this differed from the current study in which all PLWH with a history of ASCVD or T2DM received statin therapy .…”

Section: Discussioncontrasting

confidence: 72%

“…The difference in statin prescribing between HIV‐infected and uninfected patients has been reported to be as high as 22%, with gross underutilization observed in PLWH with known coronary heart disease (CHD) or risk equivalents . When statin prescribing was assessed in PLWH, less than half of patients in whom a statin was indicated were prescribed these medications (based on the 2013 American College of Cardiology/American Heart Association [ACC/AHA] treatment guidelines) . Given the increase in CVD risk in PLWH, this paper presents the outcomes of statin utilization in PLWH who received team‐based care compared with those who received standard care.…”

Section: Introductionmentioning

confidence: 99%

Impact of team‐based care on appropriate statin therapy prescribing in ***HIV‐infected patients

Hester

Caulder

Penzak

2020

J Am Coll Clin Pharm

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Introduction: Statins have historically been underutilized in patients living with ***HIV infection (PLWH) despite reported rates of cardiovascular disease twice that of the general population. Objective: To evaluate the impact of team-based pharmacy services on appropriate statin prescribing compared with standard care in an HIV primary care clinic. Methods: A retrospective chart review of adult PLWH was conducted for appropriate statin prescribing according to 2013 American College of Cardiology/American Heart Association cholesterol guidelines. Patient outcomes were stratified by team-based care defined as physician/pharmacy collaboration, and standard care defined as primary care without clinical pharmacy services. The primary outcome was the percentage of patients receiving appropriate statin therapy in the two groups. Secondary outcomes included percentage of patients receiving appropriate statin therapy, number of patients indicated for therapy but untreated, and achievement of low-density lipoprotein (LDL) goal reduction. Chi-square analysis was used for nominal comparisons, and logistic regression was used to identify predictors of appropriate statin prescribing.Results: Three hundred fifty-two charts were screened, 114 of which met inclusion criteria. Eighty-nine patients (61%) received team-based care and 25 (22%) received standard care. Appropriate statin prescribing was observed in a greater percentage of patients in the team-based care group compared with the standard care group (86% vs 54%, respectively; P < .001). More patients receiving team-based care were also prescribed statin therapy when indicated (98% vs 88%; P < .001). Team-based care was a predictor of appropriate statin prescribing (odds ratio 10.31, P < .001); however, LDL goal reduction was achieved in <30% in both groups.Conclusion: Patients living with HIV infection receiving team-based care that included a clinical pharmacist were significantly more likely to be prescribed appropriate statin therapy compared with patients receiving standard care. Nonetheless, achieving goal LDL reduction remained a challenge in these patients regardless of approach to care (team-based vs standard). K E Y W O R D S cardiovascular disease, clinical pharmacist, human immunodeficiency virus, preventive medicine, quality of care, statins

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“…Our direct comparison of ASCVD to FRS in categorizing patient as elevated CVD risk was important to perform as neither risk prediction rule was developed for HIV-infected patients in SSA. In our cohort, ASCVD classified more patients as elevated CVD risk than FRS as has been observed when these two prediction equations are compared among geographically diverse general populations beyond the US general population [ 29 – 32 ] and some HIV-specific patient population studies [ 12 ] but not all [ 11 , 13 ]. It is possible that the difference in categorizing patients at elevated risk by ASCVD versus FRS in out cohort may reflect the findings that the ASCVD may “over-estimate” risk, even in the general population.…”

Section: Discussionmentioning

confidence: 89%

“…In some HIV-cohorts, ASCVD underestimated CVD risk as compared to actual occurrence of CVD end-points [ 10 , 11 ] or presence of high risk morphology plaque [ 12 ]. Other studies have demonstrated good [ 13 ] versus poor [ 14 ] agreement with the well-established Framingham Risk Score (FRS). The FRS has been reported to accurately predict CVD risk [ 10 , 15 ], underestimate CVD risk [ 12 , 14 ] or overestimate risk [ 15 ].…”

Section: Introductionmentioning

confidence: 99%

Cardiovascular disease risk prediction by the American College of Cardiology (ACC)/American Heart Association (AHA) Atherosclerotic Cardiovascular Disease (ASCVD) risk score among HIV-infected patients in sub-Saharan Africa

et al. 2017

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ObjectivesHIV-infected patients are at increased risk for cardiovascular disease (CVD). However, general population CVD risk prediction equations that identify HIV-infected patients at elevated risk have not been widely assessed in sub-Saharan African (SSA).MethodsHIV-infected adults from 30–50 years of age with documented viral suppression were enrolled into a cross-sectional study in Gaborone, Botswana. Participants were screened for CVD risk factors. Bilateral carotid intima-media thickness (cIMT) was measured and 10-year predicted risk of cardiovascular disease was calculated using the Pooled Cohorts Equation for atherosclerotic CVD (ASCVD) and the 2008 Framingham Risk Score (FRS) (National Cholesterol Education Program III–NCEP III). ASCVD ≥7.5%, FRS ≥10%, and cIMT≥75th percentile were considered elevated risk for CVD. Agreement in classification of participants as high-risk for CVD by cIMT and FRS or ASCVD risk score was assessed using McNemar`s Test. The optimal cIMT cut off-point that matched ASCVD predicted risk of ≥7.5% was assessed using Youden’s J index.ResultsAmong 208 HIV-infected patients (female: 55%, mean age 38 years), 78 (38%) met criteria for ASCVD calculation versus 130 (62%) who did not meet the criteria. ASCVD classified more participants as having elevated CVD risk than FRS (14.1% versus 2.6%, McNemar’s exact test p = 0.01), while also classifying similar proportion of participants as having elevated CVD like cIMT (14.1% versus 19.2%, McNemar’s exact test p = 0.34). Youden’s J calculated the optimal cut point at the 81st percentile for cIMT to correspond to an ASCVD score ≥7.5% (sensitivity = 72.7% and specificity = 88.1% with area under the curve for the receiver operating characteristic [AUC] of 0.82, 95% Mann-Whitney CI: 0.66–0.99).ConclusionWhile the ASCVD risk score classified more patients at elevated CVD risk than FRS, ASCVD score classified similar proportion of patients as high risk when compared with established subclinical atherosclerosis. However, potential CVD risk category misclassification by established equations such as ASCVD may still exist among HIV-infected patients; hence there is still a need for development of a CVD risk prediction equation tailored to HIV-infected patients in SSA.

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Statin Use With the ATP III Guidelines Compared to the 2013 ACC/AHA Guidelines in HIV Primary Care Patients

Abstract: A moderate agreement was found between both guidelines in terms of statin use when applied to an HIV patient population. Based on the 2013 guidelines and taking into account drug interactions with antiretrovirals, 44.2% of the patients were treated with an incorrect statin intensity.

Cited by 7 publications

References 11 publications

Cholesterol Screening and Statin Prescription is Low Among HIV-Infected Patients on Protease-Inhibitor Regimens in Botswana

Cholesterol Screening and Statin Prescription is Low Among HIV-Infected Patients on Protease-Inhibitor Regimens in Botswana

Impact of team‐based care on appropriate statin therapy prescribing in ***HIV‐infected patients

Cardiovascular disease risk prediction by the American College of Cardiology (ACC)/American Heart Association (AHA) Atherosclerotic Cardiovascular Disease (ASCVD) risk score among HIV-infected patients in sub-Saharan Africa

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