Abstract 17129: Low Density Lipoprotein Cholesterol Response After Statin Initiation Among HIV-positive Persons With High Risk for Cardiovascular Disease Events
Introduction: The 2013 ACC/AHA cholesterol guideline recommends use of moderate- or high-intensity statins to reduce LDL-C and the risk of CVD events in high-risk groups. Meta-analyses of general population studies report median LDL-C reduction of 30% with moderate-intensity and 50% with high-intensity statins. We evaluated LDL-C response after first statin initiation among high risk HIV+ patients in the Center for AIDS Research Network of Integrated Clinical Systems (CNICS).
Methods: We conducted a retrospective cohort study including CNICS patients for 2009-2013 without prior statin use. High risk groups included patients with history of MI or coronary artery revascularization, diabetes mellitus, pre-statin LDL-C ≥190 mg/dL, and 10-year risk for first CVD event ≥7.5%.
Results: Among 14,116 patients without prior statin use, 1,229 (9%) initiated statins (mean age 50 years, 82% male, 37% African-American, 9% Hispanic). Statins were initiated at low intensity for 21% of patients and at moderate and high intensity for 63% and 9%, respectively. Mean (SD) pre-statin LDL-C was 136 (41) mg/dL and post-statin LDL-C 107 (36) mg/dL among 933 patients with available laboratory measures. Overall, 34% had a ≥30% reduction in LDL-C (Table 1). Among high risk groups, a higher proportion of patients with pre-statin LDL-C ≥190 mg/dL had a ≥30% reduction (59%). There were no statistically significant differences in the proportion of patients achieving a ≥30% LDL-C reduction between the other high risk groups (p=0.127). In a sensitivity analysis including 707 (76%) patients still taking a statin at the time of post-statin LDL-C measurement, 35% had a ≥30% reduction in LDL-C and 7% had a ≥50% reduction.
Conclusions: The majority of HIV+ patients with high CVD risk did not achieve a ≥30% LDL-C reduction following initiation of a statin. More widespread use of high-intensity statins among HIV+ persons in whom it is not contraindicated by antiretroviral drug interactions may be beneficial.
Author Disclosures: G. Burkholder: Research Grant; Modest; Amgen, Bristol Myers Squibb. Consultant/Advisory Board; Modest; Definicare LLC. P. Muntner: Research Grant; Significant; Amgen. Consultant/Advisory Board; Modest; Amgen. H. Zhao: None. M. Mugavero: None. E.T. Overton: None. M. Kilgore: Research Grant; Significant; Amgen Inc. D. Drozd: None. H. Crane: None. R. Moore: None. C. Mathews: None. E. Geng: None. S. Boswell: None. M. Floris-Moore: None. B. Taylor: Employment; Significant; Amgen, Inc. K. Monda: Employment; Significant; Amgen, Inc. R.S. Rosenson: Research Grant; Significant; Amgen, AstraZeneca, Catabasis, Medicines Company, Sanofi. Honoraria; Modest; Kowa. Consultant/Advisory Board; Modest; Amgen, Akcea, AstraZeneca, CVS Caremark, Eli Lilly, GSK, Sanofi.
- © 2016 by American Heart Association, Inc.