Impact of the American College of Cardiology/American Heart Association Cholesterol Guidelines on Statin Eligibility Among Human Immunodeficiency Virus-Infected Individuals

BACKGROUND: Individuals with human immunodeficiency virus (HIV) face elevated cardiovascular disease (CVD) risk. There are limited data regarding the application of the American College of Cardiology/American Heart Association (ACC/AHA) cholesterol guidelines in HIV compared with non-HIV patients. METHODS: Human immunodeficiency virus-infected and demographically similar control patients were assessed for statin recommendation status by ACC/AHA and the National Cholesterol Education Program Adult Treatment Program III (ATPIII), indication for statin recommendation, actual statin prescription, and CVD event. Outcomes were atherosclerotic CVD for ACC/AHA and coronary heart disease for ATPIII. RESULTS: In a clinical care cohort of 1394 patients infected with HIV, 38.6% (538 of 1394) of patients were recommended for statin therapy by the ACC/AHA guidelines compared with 20.1% (280 of 1394) by the ATPIII guidelines. Of those recommended for statin therapy, actual statin prescription rates were 42.8% (230 of 538) for ACC/AHA and 66.4% (186 of 280) for ATPIII. Among patients infected with HIV with an incident CVD event during follow-up, statin therapy was recommended for 59.2% (42 of 71) of patients by ACC/AHA and 35.2% (25 of 71) by ATPIII, versus 71.6% (141 of 197) by ACC/AHA and 43.1% (85 of 197) by ATPIII in the control group. CONCLUSIONS: In an HIV clinical care cohort, the ACC/AHA cholesterol guidelines recommend a higher proportion of patients for statin therapy and identify an increased proportion of patients with a CVD event compared with ATPIII. However, 40% of patients with a CVD event would not have been recommended for statin therapy by ACC/AHA, compared with 29% for controls. This gap in identification of patients infected with HIV at high CVD risk underscores the need for HIV-specific cardiovascular prevention strategies.