Suboptimal primary and secondary cardiovascular disease prevention in HIV-positive individuals on antiretroviral therapy

Rosan A van Zoest, Marc van der Valk, Ferdinand W Wit, Ilonca Vaartjes, Katherine W Kooij, Joppe W Hovius, Maria Prins, Peter Reiss, AGEhIV Cohort Study Group, Rosan A van Zoest, Marc van der Valk, Ferdinand W Wit, Ilonca Vaartjes, Katherine W Kooij, Joppe W Hovius, Maria Prins, Peter Reiss, AGEhIV Cohort Study Group

Abstract

Background We aimed to identify the prevalence of cardiovascular risk factors, and investigate preventive cardiovascular medication use and achievement of targets as per Dutch cardiovascular risk management guidelines among human immunodeficiency virus (HIV)-positive and HIV-negative individuals. Design The design was a cross-sectional analysis within an ongoing cohort study. Methods Data on medication use and cardiovascular disease prevalence were available for 528 HIV-positive and 521 HIV-negative participants. We identified cardiovascular risk factors and applied cardiovascular risk management guidelines, mainly focusing on individuals eligible for (a) primary prevention because of high a priori cardiovascular risk, or for (b) secondary prevention. Results One hundred and three (20%) HIV-positive and 77 (15%) HIV-negative participants were classified as having high cardiovascular risk; 53 (10%) HIV-positive and 27 (5%) HIV-negative participants were eligible for secondary prevention. Of HIV-positive individuals 57% at high cardiovascular risk and 42% of HIV-positive individuals eligible for secondary prevention had systolic blood pressures above guideline-recommended thresholds. Cholesterol levels were above guideline-recommended thresholds in 81% of HIV-positive individuals at high cardiovascular risk and 57% of HIV-positive individuals eligible for secondary prevention. No statistically significant differences were observed between HIV-positive and HIV-negative participants regarding achievement of targets, except for glycaemic control (glycated haemoglobin ≤ 53 mmol/mol) among individuals using diabetes medication (90% vs 50%, p = 0.017) and antiplatelet/anticoagulant use for secondary prevention (85% vs 63%, p = 0.045), which were both superior among HIV-positive participants. Conclusions Cardiovascular risk management is suboptimal in both HIV-positive and HIV-negative individuals and should be improved.

Keywords: Human immunodeficiency virus; cardiovascular disease; dyslipidaemia; hypertension; prevention.

Figures

Figure 1.
Figure 1.
Predicted 10-year cardiovascular risk among human immunodeficiency virus (HIV)-positive and HIV-negative participants without prior cardiovascular disease (CVD). The figure shows the proportion of participants in low (aNon-parametric trend test.
Figure 2.
Figure 2.
Proportions of human immunodeficiency virus (HIV)-positive (HIV+) and HIV-negative (HIV–) individuals (a) below/above the recommended systolic blood pressure (SBP) and (b) cholesterol thresholds, and proportions using antihypertensive and lipid-lowering medication; (a) illustrates the proportion of individuals below (green) or above (red) the recommended SBP threshold for treatmentb among HIV-positive and HIV-negative participants, with the bars in grey indicating the proportion of individuals who do (upward diagonal lines) or do not (solid fill) use antihypertensive medication, stratified by cardiovascular risk group; (b) shows the proportion of individuals below (green) or above (red) the recommended cholesterol thresholds for treatmentc among HIV-positive and HIV-negative participants, with the bars in grey demonstrating the proportion of individuals who do (upward diagonal lines) or do Figure 2. Continued not (solid fill) use lipid-lowering medication, stratified by cardiovascular risk group. The numbers below the graph show the number of participants within each group. Data are presented as percentages. High risk: 10-year cardiovascular risk≥20% or 10-year cardiovascular risk 10–20% with additional cardiovascular risk factors; low risk: 10-year cardiovascular risk<10%; moderate risk: 10-year cardiovascular risk 10–20% without additional cardiovascular risk factors. LDL-c: low-density lipoprotein cholesterol; TC/HDL-ratio, total cholesterol/ high-density lipoprotein cholesterol ratio. aFisher’s exact test; group comparison of HIV-positive versus HIV-negative individuals below or above the recommended threshold for treatment in each risk stratum. bSBP thresholds differ between and within the different subgroups: (a) SBP > 180 mm Hg in participants with primary prevention low 10-year cardiovascular risk or moderate 10-year cardiovascular risk participants with no additional risk factors; or (b) SBP > 160 mm Hg in participants aged ≥80 years with primary prevention high 10-year cardiovascular risk; or (c) SBP > 140 mm Hg in participants aged <80 years with primary prevention high 10-year cardiovascular risk, or those eligible for secondary prevention; cPlasma lipid levels are above the threshold when (a) TC/HDL-ratio>8 (regardless of cardiovascular risk), or (b) LDL-cholesterol>2.5 mmol/l in participants with primary prevention high 10-year cardiovascular risk, or eligible for secondary prevention.

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Source: PubMed

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