Key result
The 2013 ACC/AHA guidelines recommended statin therapy for a higher percentage of HIV-infected subjects with HRM coronary plaque compared to 2004 guidelines (26% vs 10%, P=0.04).
Why the study?
Does the 2013 ACC/AHA cholesterol guideline recommend statin therapy for more HIV-infected patients with subclinical high-risk coronary plaque compared to the 2004 ATP III guideline?
Cross-Sectional (n=108)
Does the 2013 ACC/AHA cholesterol guideline recommend statin therapy for more HIV-infected patients with subclinical high-risk coronary plaque compared to the 2004 ATP III guideline?
While the 2013 ACC/AHA guidelines increase statin recommendations compared to 2004 guidelines in HIV patients, they still fail to recommend statins for the majority (74%) of those with subclinical high-risk coronary plaque.
Answers are grounded in this paper and cite their sources.
Even 2013 guidelines leave most HIV patients with high-risk plaque statin-ineligible; leaves open need for HIV-specific validation.
BACKGROUND: The 2013 American College of Cardiology/American Heart Association (ACC/AHA) cholesterol guidelines are being applied to HIV-infected patients but have not been validated in this at-risk population, which is known to have a high prevalence of subclinical high-risk morphology (HRM) coronary atherosclerotic plaque. OBJECTIVE: To compare recommendations for statins among HIV-infected subjects with/without HRM coronary plaque according to 2013 ACC/AHA versus 2004 Adult Treatment Panel III guidelines. METHODS/DESIGN: Data from 108 HIV-infected subjects without known cardiovascular disease (CVD) or lipid-lowering treatment who underwent contrast-enhanced computed tomography angiography were analyzed. Recommendations for statin therapy according to 2013 versus 2004 guidelines were assessed among those with/without HRM coronary plaque. RESULTS: Among all subjects, 10-year atherosclerotic cardiovascular disease (ASCVD) risk score was 3.3% (1.6, 6.6), yet 36% of subjects had HRM coronary plaque. Among those with HRM coronary plaque, statins would be recommended for 26% by 2013 guidelines versus 10% by 2004 guidelines (P = 0.04). Conversely, among those without HRM coronary plaque, statins would be recommended for 19% by 2013 guidelines versus 7% by 2004 guidelines (P = 0.005). In multivariate modeling, while 10-year ASCVD risk score related to HRM coronary plaque burden (P = 0.02), so too did other factors not incorporated into 2013 guidelines. CONCLUSION: The 2013 ACC/AHA cholesterol guidelines recommend statin therapy for a higher percentage of subjects with and without HRM coronary plaque relative to 2004 guidelines. However, even by 2013 guidelines, statin therapy would not be recommended for the majority (74%) of HIV-infected subjects with subclinical HRM coronary plaque. Outcome studies are needed to determine the utility of new statin recommendations and the contribution of HRM coronary plaque to CVD events among HIV-infected subjects.
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Zanni et al. (2014) conducted a cross-sectional in HIV infection (n=108). 2013 ACC/AHA cholesterol guidelines vs. 2004 Adult Treatment Panel III guidelines was evaluated on Recommendation for statin therapy among subjects with high-risk morphology (HRM) coronary plaque (p=0.04). The 2013 ACC/AHA guidelines recommended statin therapy for a higher percentage of HIV-infected subjects with HRM coronary plaque compared to 2004 guidelines (26% vs 10%, P=0.04).
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