Missed Opportunities for Primary Prevention of Cardiovascular Disease in an HIV Clinic

BACKGROUND: Atherosclerotic cardiovascular disease (ASCVD) is a leading cause of death among people living with HIV (PLWH). PLWH have a high prevalence of ASCVD risk factors, including hypertension (HTN), dyslipidemia, diabetes mellitus (DM), elevated BMI, smoking, physical inactivity, and poor diet. METHODS: Setting—Urban Ryan White funded clinic in Columbia, SC providing care to about 2200 PLWH. A retrospective chart review was performed on a sample of patients ≥40 years old. Patients were eligible if they did not have a known diagnosis of ASCVD, had ≥ 3 visits in the last 3 years, and at least 1 visit in the past 12 months. Data regarding demographics, comorbidities, lab values, medications, and recent blood pressures were abstracted. Data were collected on assessment and intervention for smoking, weight loss, diet, and exercise. Objectives of this study were to: (1) determine the prevalence of ASCVD risk factors among patients without known ASCVD; (2) estimate the proportion of patients who received appropriate pharmacologic and lifestyle interventions. RESULTS: Charts were reviewed in random order until 100 charts had the required variables to calculate the 10-year ASCVD risk (Figure 1). These complete charts were similar in demographic characteristics to the clinic population. Of the complete charts, 66% met BMI criteria for being obese or overweight; but < 30% of these patients had documentation of the diagnosis, or received appropriate intervention for diet, exercise, or weight loss. HTN was diagnosed in 42% of patients, and 52% of these were adequately controlled. An additional 9% met criteria for HTN but did not carry the diagnosis. Documented diagnosis of DM was surprisingly low at <5%. Nurses assessed smoking in 100% of patients, and the majority of smokers received an intervention. Based on current guidelines, less than 25% of eligible patients were prescribed a statin (Figure 2). To our concern, none of the patients with LDL ≥190 mg/dL or DM had evidence of statin therapy. CONCLUSION: Although > 85% of clinic patients have an undetectable HIV viral load, there were multiple missed opportunities for primary prevention of cardiovascular disease, including interventions for smoking cessation, diet and exercise, and guideline based anti-HTN and statin therapy. DISCLOSURES: A. Jones, Proctor & Gamble: Stock, Dividend. CVS Health Corp: Stock, Dividend. Johnson & Johnson: Stock, Dividend. Baxter Inc.: Stock, Dividend. Becton-Dickinson: Stock, Dividend. United Health Group: Stock, Dividend