Low-density lipoprotein cholesterol response after statin initiation among persons living with human immunodeficiency virus

Affiliations

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.

PMID: 29853312
PMCID: PMC9113294
DOI: 10.1016/j.jacl.2018.03.082

Low-density lipoprotein cholesterol response after statin initiation among persons living with human immunodeficiency virus

Greer A Burkholder et al. J Clin Lipidol. 2018 Jul-Aug.

. 2018 Jul-Aug;12(4):988-998.e5.

doi: 10.1016/j.jacl.2018.03.082. Epub 2018 Mar 29.

Authors

Affiliations

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.

PMID: 29853312
PMCID: PMC9113294
DOI: 10.1016/j.jacl.2018.03.082

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.

Keywords: Cardiovascular disease; Dyslipidemia; HIV infection; Low-density lipoprotein cholesterol; Statin.

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Figures

**Figure 1:**
Patients included in the current analysis

**Figure 2:**
Percentage of patients in the Centers for AIDS Research Network of Integrated Clinical Systems initiating statins who received high-, moderate-, and low-intensity statins Abbreviations: ASCVD, atherosclerotic cardiovascular disease; CHD, coronary heart disease; LDL-C, low density lipoprotein cholesterol

See this image and copyright information in PMC

References

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Low-density lipoprotein cholesterol response after statin initiation among persons living with human immunodeficiency virus

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Low-density lipoprotein cholesterol response after statin initiation among persons living with human immunodeficiency virus

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