Use of Preventive Measures for Cardiovascular Disease in People With HIV

Abstract

Background: Data on uptake of preventive measures for cardiovascular disease (CVD) in people with HIV are limited.

Methods: We determined the annual prevalence (2012-2021) of CVD preventive measures use for RESPOND participants with a very high (>10%) estimated D:A:D 10-year CVD risk who were eligible for each specific measure evaluated. We used binomial regression to assess factors associated with each preventative measure uptake.

Results: Between 2012 and 2021, the crude proportion of >10% estimated 10-year CVD risk individuals increased from 32.4% (n = 4272) to 52.1% (n = 5298). At the end of follow-up, among very high-risk individuals, 67.4% (1552/2303) with hypertension used antihypertensives, 55.9% (1562/2792) with dyslipidemia lipid-lowering drugs (LLDs), and 7.4% (159/2149) smokers ceased smoking, without significant changes over time. Conversely, a smaller proportion of individuals with diabetes received antidiabetics in later years (2012-2013: 60.3% [388/643] versus 2019-2020: 57.2% [459/803], global P = .0028). Use of angiotensin-converting enzyme inhibitors/angiotensin receptor blockers (ACEIs/ARBs) in those with hypertension or diabetes slightly declined before increasing again (42.1% [864/2052] versus 43.4% [1123/2585], global P = .0009). Individuals with ongoing viremia or intravenous drug use as HIV exposure group were less likely to cease smoking and use LLDs. Men ≥40 years and women ≥50 were more likely to use antihypertensives, ACEIs/ARBs, antidiabetics, and LLDs. The uptake of preventive measures was similar between sexes/genders.

Conclusions: The increasing proportion of individuals at very high estimated 10-year CVD risk without a corresponding increase in use of preventive measures calls for greater awareness of CVD risk management for people with HIV attending routine clinical care.

Keywords: HIV; cardiovascular disease; cohort.

Figure 1.

Exclusion flowchart. *More than 1 reason can apply. +Including transgender. Estimated CVD risk score categories were assessed at baseline. CVD, cardiovascular disease; HDL, high-density lipoprotein; SBP, systolic blood pressure; VL, viral load.

Figure 2.

Temporal proportions of estimated 10-y D:A:D CVD risk. All proportions were assessed on 1 July of the calendar year and participants were not allowed to reverse to a lower risk category. Mean age increased from 47 y in 2012 to 51 y in 2020, mean cumulative exposure to nucleoside/nucleotide reverse transcriptase inhibitors increased from 8.6 y to 12.5 y, number of participants currently using abacavir increased from 23% (3037/13 199) to 36% (5950/16 256).

Figure 3.

Temporal proportions of CVD preventive measures use among eligible individuals with >10% estimated 10-y CVD risk. All P values are global, multivariate P values for each preventive measure with calendar years per 2-y groups. n = individuals eligible for each of the respective preventive measure. Antihypertensive medication also includes ACEIs and ARBs. ABC, abacavir; ACEI, angiotensin-converting enzyme inhibitor; ARB, angiotensin receptor blocker; CVD, cardiovascular disease; DRV, darunavir; LLD, lipid-lowering drug; LPV, lopinavir.

Figure 4.

Adjusted odds ratios of CVD preventive measures use among eligible individuals with >10% estimated 10-y CVD risk for key subgroups. aOR adjusted for age (<40/≥40 men, < 50/≥50 women), sex/gender (male, female), ethnicity (white, other, unknown), SCORE-2 CVD risk region (low, moderate, high, very high), BMI (<30, ≥ 30 kg/m², unknown; not included for weight loss), HIV acquisition risk (MSM, IDU, heterosexual, other), CD4 cell count, CD4 nadir, ART experience (ART naïve, VL <200 copies/mL, VL >200 copies/mL), hypertension (yes, no; not included for antihypertensives and ACEIs/ARBs), diabetes (yes, no; not included for diabetic medication and ACEIs/ARBs), prior AIDS (yes, no), prior cancer (yes, no), prior CKD (yes, no), dyslipidaemia (yes, no; not included for LLDs), all fixed at baseline. Calendar year, current smoking status (current, past, never; not included for smoking cessation), cumulative exposure to LPV/r (not included for LPV/r discontinuation), DRV/b (not included for DRV/b discontinuation), and IDV, ABC use in the past 6 months (not included for ABC discontinuation), and INSTIs exposure (0, 0–6, 6–12, 12–24, 24–36, >36 m), all time updated. Use of antihypertensive medication, antidiabetic medication and LLDs was less likely in current smokers (vs non-smokers). Antihypertensive medication also include ACEIs and ARBs. +Age subgroup: < 40/≥40 y of age for men, < 50/≥50 for women. *Not including diabetes as a subgroup since it is part of the eligibility criteria for ACEIs/ARBs and antidiabetic medication. aORs included all observations within the study period, accounting for repeated measures through generalized estimating equations. ABC, abacavir; ACEI, angiotensin-converting enzyme inhibitor; aOR, adjusted odds ratio; ARB, angiotensin receptor blocker; ART, antiretroviral treatment; BMI, body mass index; CI, confidence interval; CKD, chronic kidney disease; CVD, cardiovascular disease; DRV, darunavir; IDU, intravenous drug use; IDV, indinavir; INSTI, integrase strand transfer inhibitor; LLD, lipid-lowering drug; LPV, lopinavir; VL, viral load.