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  Reported by Jules Levin
IDWeek Oct 26-30
New Orleans 2016
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One Third of HIV Group With Statin Indication Not Getting Statins - - Mt Sinai NYC, Optimizing Cardiovascular Risk Prevention in an Urban HIV Clinic
  IDWeek 2016, October 26-30, 2016, New Orleans
At the Aging Workshop last month - Up to Half in Older DC Cohort Not Treated for Metabolic Comorbidities - High Burden of Comorbidities in Inner City Washington DC -- (09/27/16)..... Based on the available electronic medical record data, 38% lacked evidence of treatment for hypertension, 40% lacked evidence of treatment for diabetes, and 66% lacked evidence of treatment for dyslipidemia (after excluding the 19% of dyslipidemic patients whose only indication for dyslipidemia was low HDL-C, 56% lacked evidence of treatment).
.....Most metabolic comorbidities were substantially more prevalent among older age groups: 74% of patients aged 60-69 and 86% aged ≥70 had hypertension; 24% aged 60-69 and 29% aged ≥70 had type 2 diabetes; and 68% aged 60-69 and 74% aged ≥70 had dyslipidemia..... Among patients aged ≥70, 78% had ≥2 metabolic comorbidities, including 44% with exactly two comorbidities, 27% with exactly 3 comorbidities, and 7% with all four comorbidities.


Mark Mascolini
One third of an urban HIV group with atherosclerotic cardiovascular disease (ASCVD) and an indication for a statin did not take a statin in a 1150-person analysis [1]. The same proportion with diabetes and a statin indication did not take a statin [1]. The study linked smoking to a lower chance of statin prescription, and more than one third of the cohort smoked.
Plentiful research confirms the heightened risk of cardiovascular disease in HIV-positive people compared with the general population. Statin therapy has been much studied in HIV populations and some work addresses aspirin prophylaxis in people with HIV. But few studies have addressed statin or aspirin prescription patterns in HIV-positive people with ASCVD or at high risk of ASCVD. Researchers at New York's Icahn School of Medicine at Mount Sinai addressed those questions in a retrospective chart review.
The analysis involved HIV-positive adults who had at least two primary care visits from July 2014 through June 2015. The investigators defined ASCVD as myocardial infarction, coronary heart disease, stroke, transient ischemic attack, ischemic heart disease, stable or unstable angina, peripheral arterial disease, peripheral vascular disease, atheroembolism, or cerebrovascular disease. The Mount Sinai team checked patient charts to see how many with (1) an ASCVD diagnosis, (2) diabetes and LDL-cholesterol above 70 mg/dL, and (3) LDL-cholesterol at or above 190 mg/dL got a prescription for a statin or aspirin according to 2013 ACC/AHA statin guidelines or 2011 AHA/ACCF aspirin guidelines.
The analysis involved 1150 people in care over the study period, of whom 231 (20%) fell into one of the three high-risk groups: 141 (61% of 231) with an ASCVD diagnosis, 85 (37%) with diabetes and LDL cholesterol above 70 mg/dL, and 5 (2%) with LDL cholesterol at or above 190 mg/dL. Eighty-six of these 231 people (37%) were active smokers.
Among the 141 people with an ASCVD diagnosis, 79 (56%) were taking a statin and 45 with a statin indication (32%) were not taking a statin. In this group 100 people (71%) were taking aspirin and 17 (12%) with an aspirin indication were not.
Among the 85 people with a diabetes diagnosis, 48 (56%) were taking a statin and 27 (32%) with a statin indication were not. Among the 5 people with LDL cholesterol at or above 190, 3 (60%) were taking a statin and 2 (40%) with a statin indication were not. In this group 1 was taking aspirin and 4 with an aspirin indication were not.
Among 130 people taking a statin, 43 (33%) were active smokers. In contrast, among the 128 people not on a statin, 56 (44%) were active smokers.
The investigators concluded that "we are underutilizing ASCVD prevention tools in HIV-positive patients."
1. Kaplan-Lewis E, Aberg JA, O'Brien M. Optimizing cardiovascular risk prevention in an urban HIV clinic. IDWeek 2016, October 26-30, 2016, New Orleans. Abstract 2137.