Greer A Burkholder1, Paul Muntner2, Hong Zhao2, Michael J Mugavero3, E Turner Overton3, Meredith Kilgore4, Daniel R Drozd5, Heidi M Crane5, Richard D Moore6, Wm Christopher Mathews7, Elvin Geng8, Stephen Boswell9, Michelle Floris-Moore10, Robert S Rosenson11. 1. Department of Medicine, Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham, AL, USA. Electronic address: gburkholder@uabmc.edu. 2. Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA. 3. Department of Medicine, Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham, AL, USA. 4. Department of Health Care Organization and Policy, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA. 5. Department of Medicine, University of Washington, Seattle, WA, USA. 6. Department of Medicine, Johns Hopkins University, Baltimore, MD, USA. 7. Department of Medicine, University of California San Diego, San Diego, CA, USA. 8. Department of Medicine, University of California San Francisco, San Francisco, CA, USA. 9. Department of Medicine, Harvard Medical School, Boston, MA, USA. 10. Department of Medicine, Division of Infectious Diseases, University of North Carolina School of Medicine, Chapel Hill, NC, USA. 11. Department of Medicine, Mount Sinai Icahn School of Medicine, New York, NY, USA.
Abstract
BACKGROUND: Meta-analyses of general population studies report mean low-density lipoprotein cholesterol (LDL-C) reductions of 30% to <50% with moderate-intensity and ≥50% with high-intensity statins. Persons living with human immunodeficiency virus (PLWH) are at high risk for atherosclerotic cardiovascular disease (ASCVD), yet many have elevated LDL-C. OBJECTIVE: To evaluate LDL-C response after statin initiation among PLWH. METHODS: We conducted a retrospective cohort study of PLWH initiating statins between 2009 and 2013 (N = 706). Patients were categorized into mutually exclusive groups in the following hierarchy: history of coronary heart disease (CHD), diabetes, prestatin LDL-C ≥190 mg/dL, 10-year predicted ASCVD risk ≥7.5%, and none of the above (ie, unknown statin indication). The primary outcome was a ≥30% reduction in LDL-C after statin initiation. RESULTS: Among patients initiating statins, 5.8% had a history of CHD, 13.6% had diabetes, 6.2% had LDL-C ≥190 mg/dL, 35.4% had 10-year ASCVD risk ≥7.5%, and 39.0% had an unknown statin indication. Among patients with a history of CHD, 31.7% achieved a ≥30% LDL-C reduction compared with 25.0%, 59.1%, and 33.9% among those with diabetes, LDL-C ≥190 mg/dL, and 10-year ASCVD risk ≥7.5%, respectively. In multivariable adjusted analyses and compared to patients with an unknown statin indication, LDL-C ≥ 190 mg/dL was associated with a prevalence ratio for an LDL-C reduction ≥30% of 1.81 (95% confidence interval, 1.34-2.45), whereas no statistically significant association was present for history of CHD, diabetes, and 10-year ASCVD risk ≥7.5%. CONCLUSION: A low percentage of PLWH achieved the expected reductions in LDL-C after statin initiation, highlighting an unmet need for ASCVD risk reduction.
BACKGROUND: Meta-analyses of general population studies report mean low-density lipoprotein cholesterol (LDL-C) reductions of 30% to <50% with moderate-intensity and ≥50% with high-intensity statins. Persons living with human immunodeficiency virus (PLWH) are at high risk for atherosclerotic cardiovascular disease (ASCVD), yet many have elevated LDL-C. OBJECTIVE: To evaluate LDL-C response after statin initiation among PLWH. METHODS: We conducted a retrospective cohort study of PLWH initiating statins between 2009 and 2013 (N = 706). Patients were categorized into mutually exclusive groups in the following hierarchy: history of coronary heart disease (CHD), diabetes, prestatin LDL-C ≥190 mg/dL, 10-year predicted ASCVD risk ≥7.5%, and none of the above (ie, unknown statin indication). The primary outcome was a ≥30% reduction in LDL-C after statin initiation. RESULTS: Among patients initiating statins, 5.8% had a history of CHD, 13.6% had diabetes, 6.2% had LDL-C ≥190 mg/dL, 35.4% had 10-year ASCVD risk ≥7.5%, and 39.0% had an unknown statin indication. Among patients with a history of CHD, 31.7% achieved a ≥30% LDL-C reduction compared with 25.0%, 59.1%, and 33.9% among those with diabetes, LDL-C ≥190 mg/dL, and 10-year ASCVD risk ≥7.5%, respectively. In multivariable adjusted analyses and compared to patients with an unknown statin indication, LDL-C ≥ 190 mg/dL was associated with a prevalence ratio for an LDL-C reduction ≥30% of 1.81 (95% confidence interval, 1.34-2.45), whereas no statistically significant association was present for history of CHD, diabetes, and 10-year ASCVD risk ≥7.5%. CONCLUSION: A low percentage of PLWH achieved the expected reductions in LDL-C after statin initiation, highlighting an unmet need for ASCVD risk reduction.
Authors: Sudershan Singh; James H Willig; Michael J Mugavero; Paul K Crane; Robert D Harrington; Robert H Knopp; Bradley W Kosel; Michael S Saag; Mari M Kitahata; Heidi M Crane Journal: Clin Infect Dis Date: 2010-12-28 Impact factor: 9.079
Authors: Terry A Jacobson; Kevin C Maki; Carl E Orringer; Peter H Jones; Penny Kris-Etherton; Geeta Sikand; Ralph La Forge; Stephen R Daniels; Don P Wilson; Pamela B Morris; Robert A Wild; Scott M Grundy; Martha Daviglus; Keith C Ferdinand; Krishnaswami Vijayaraghavan; Prakash C Deedwania; Judith A Aberg; Katherine P Liao; James M McKenney; Joyce L Ross; Lynne T Braun; Matthew K Ito; Harold E Bays; W Virgil Brown; James A Underberg Journal: J Clin Lipidol Date: 2015-09-18 Impact factor: 4.766
Authors: Qing Huang; Michael Grabner; Robert J Sanchez; Vincent J Willey; Mark J Cziraky; Swetha R Palli; Thomas P Power Journal: Am Health Drug Benefits Date: 2016-11
Authors: Heidi M Crane; Pathmaja Paramsothy; Daniel R Drozd; Robin M Nance; J A Chris Delaney; Susan R Heckbert; Matthew J Budoff; Greer A Burkholder; James H Willig; Michael J Mugavero; William C Mathews; Paul K Crane; Richard D Moore; Joseph J Eron; Sonia Napravnik; Peter W Hunt; Elvin Geng; Priscilla Hsue; Carla Rodriguez; Inga Peter; Greg S Barnes; Justin McReynolds; William B Lober; Kristina Crothers; Matthew J Feinstein; Carl Grunfeld; Michael S Saag; Mari M Kitahata Journal: JAMA Cardiol Date: 2017-03-01 Impact factor: 14.676
Authors: David C Goff; Donald M Lloyd-Jones; Glen Bennett; Sean Coady; Ralph B D'Agostino; Raymond Gibbons; Philip Greenland; Daniel T Lackland; Daniel Levy; Christopher J O'Donnell; Jennifer G Robinson; J Sanford Schwartz; Susan T Shero; Sidney C Smith; Paul Sorlie; Neil J Stone; Peter W F Wilson Journal: J Am Coll Cardiol Date: 2013-11-12 Impact factor: 24.094
Authors: Fehmida Visnegarwala; Mario Maldonado; Prasuna Sajja; Jennifer L Minihan; Maria C Rodriguez-Barradas; Oliver Ong; Christopher J Lahart; Mirza Qasim Hasan; Ashok Balasubramanyam; A Clinton White Journal: J Infect Date: 2004-11 Impact factor: 6.072
Authors: Robert S Rosenson; Demetria Hubbard; Keri L Monda; Stephanie R Reading; Ligong Chen; Paul J Dluzniewski; Greer A Burkholder; Paul Muntner; Lisandro D Colantonio Journal: J Am Heart Assoc Date: 2019-12-27 Impact factor: 5.501