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Statin gap in patients living with HIV: assessing dose appropriateness
Objectives Patients living with HIV (PLWH) are predisposed to atherosclerotic cardiovascular disease (ASCVD), resulting in concomitant antiretroviral and statin use. A statin prescribing gap for PLWH has been reported, but appropriateness of statin selection and dosing (ASD) has not been described....
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| Published in: | HIV medicine 2021-11, Vol.22 (10), p.917-923 |
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| Main Authors: | , , , , , , , |
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| cited_by | cdi_FETCH-LOGICAL-c3530-8f7fc330fd0fe0fed56dbb1d1814fb798198d808718390eca3dfb27489552b5d3 |
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| cites | cdi_FETCH-LOGICAL-c3530-8f7fc330fd0fe0fed56dbb1d1814fb798198d808718390eca3dfb27489552b5d3 |
| container_end_page | 923 |
| container_issue | 10 |
| container_start_page | 917 |
| container_title | HIV medicine |
| container_volume | 22 |
| creator | Pincus, Kathleen J. Blackman, Alison L. Suen, Samuel Y. Devabhakthuni, Sandeep Gale, Stormi Noel, Zachary R. Seung, Hyunuk Pandit, Neha Sheth |
| description | Objectives
Patients living with HIV (PLWH) are predisposed to atherosclerotic cardiovascular disease (ASCVD), resulting in concomitant antiretroviral and statin use. A statin prescribing gap for PLWH has been reported, but appropriateness of statin selection and dosing (ASD) has not been described.
Methods
This is a comparative, retrospective study reviewing ASD in PLWH vs. uninfected patients at two outpatient clinics within an academic medical centre. Adults > 21 years old indicated for statin therapy were included. The primary outcome was percentage of PLWH prescribed an appropriately dosed statin, accounting for clinical‐ and patient‐related variables, compared with uninfected patients. The secondary outcome was to identify patient characteristics associated with inappropriately dosed statins.
Results
After propensity score matching, 879 PLWH and 879 uninfected patients were included for analysis. Fewer PLWH (27.8%, n = 244) were prescribed an ASD compared with uninfected patients (40.5%, n = 356, P |
| doi_str_mv | 10.1111/hiv.13150 |
| format | article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_2559661673</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2583484282</sourcerecordid><originalsourceid>FETCH-LOGICAL-c3530-8f7fc330fd0fe0fed56dbb1d1814fb798198d808718390eca3dfb27489552b5d3</originalsourceid><addsrcrecordid>eNp1kF1LwzAUhoMobn5c-Aek4I1edMtH06beyXBuMPDCj9uQNsmW0bW16Tb27z1bpxeCIXCSw8ObkwehG4IHBNZw4TYDwgjHJ6hPoliEhKbs9HCOQhrHtIcuvF9iTBKW4nPUYxGLU8xpH43fWtW6MpirOoBSw8WUrQ8Kt3HlPNi6dhFMpp-PgfLeeL_v6cqbQNV1U9WNU60poX-FzqwqvLk-1kv0MX5-H03C2evLdPQ0C3PGGQ6FTWzOGLYaWwNb81hnGdFEkMhmSSpIKrTAIiECBjW5YtpmNIlEyjnNuGaX6L7Lhde_1sa3cuV8bopClaZae0k5T-OYxAkD9O4PuqzWTQnTASVYJCIqKFAPHZU3lfeNsRI-tVLNThIs93IlyJUHucDeHhPX2croX_LHJgDDDti6wuz-T5JgtIv8Bp_XgiA</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2583484282</pqid></control><display><type>article</type><title>Statin gap in patients living with HIV: assessing dose appropriateness</title><source>Wiley</source><creator>Pincus, Kathleen J. ; Blackman, Alison L. ; Suen, Samuel Y. ; Devabhakthuni, Sandeep ; Gale, Stormi ; Noel, Zachary R. ; Seung, Hyunuk ; Pandit, Neha Sheth</creator><creatorcontrib>Pincus, Kathleen J. ; Blackman, Alison L. ; Suen, Samuel Y. ; Devabhakthuni, Sandeep ; Gale, Stormi ; Noel, Zachary R. ; Seung, Hyunuk ; Pandit, Neha Sheth</creatorcontrib><description>Objectives
Patients living with HIV (PLWH) are predisposed to atherosclerotic cardiovascular disease (ASCVD), resulting in concomitant antiretroviral and statin use. A statin prescribing gap for PLWH has been reported, but appropriateness of statin selection and dosing (ASD) has not been described.
Methods
This is a comparative, retrospective study reviewing ASD in PLWH vs. uninfected patients at two outpatient clinics within an academic medical centre. Adults > 21 years old indicated for statin therapy were included. The primary outcome was percentage of PLWH prescribed an appropriately dosed statin, accounting for clinical‐ and patient‐related variables, compared with uninfected patients. The secondary outcome was to identify patient characteristics associated with inappropriately dosed statins.
Results
After propensity score matching, 879 PLWH and 879 uninfected patients were included for analysis. Fewer PLWH (27.8%, n = 244) were prescribed an ASD compared with uninfected patients (40.5%, n = 356, P < 0.001). Similar rates of statin omission were seen in both populations (P = 0.11). More PLWH received too low a dose compared with the uninfected population (P < 0.0064). There were lower ASD rates in PLWH for subgroups of patients with clinical ASCVD (P = 0.00013) and 10‐year ASCVD risk ≥7.5% (P = 0.00055), but not in patients with low‐density lipoprotein cholesterol ≥190 mg/dL or diabetes.
Conclusions
Although a statin gap exists in both PLWH and uninfected patients, the clinical significance may be greater for PLWH given the increased risk of ASCVD. This study confirms a larger statin gap in PLWH, particularly when underdosing of statin medications is considered. Additional analysis is warranted to investigate reasons for the ASD gap and beneficial clinical interventions.</description><identifier>ISSN: 1464-2662</identifier><identifier>EISSN: 1468-1293</identifier><identifier>DOI: 10.1111/hiv.13150</identifier><identifier>PMID: 34369052</identifier><language>eng</language><publisher>England: Wiley Subscription Services, Inc</publisher><subject>Adult ; Antiretroviral agents ; Arteriosclerosis ; Atherosclerosis ; Atherosclerosis - drug therapy ; atherosclerotic cardiovascular disease ; Cardiovascular diseases ; Cholesterol ; Cholesterol, LDL ; Diabetes mellitus ; Dosage ; Health care facilities ; HIV ; HIV Infections - complications ; HIV Infections - drug therapy ; Human immunodeficiency virus ; Humans ; Hydroxymethylglutaryl-CoA Reductase Inhibitors - therapeutic use ; lipids ; Patients ; Retrospective Studies ; Statins ; Subgroups ; Young Adult</subject><ispartof>HIV medicine, 2021-11, Vol.22 (10), p.917-923</ispartof><rights>2021 British HIV Association</rights><rights>2021 British HIV Association.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c3530-8f7fc330fd0fe0fed56dbb1d1814fb798198d808718390eca3dfb27489552b5d3</citedby><cites>FETCH-LOGICAL-c3530-8f7fc330fd0fe0fed56dbb1d1814fb798198d808718390eca3dfb27489552b5d3</cites><orcidid>0000-0003-4446-5742 ; 0000-0002-0957-8197 ; 0000-0002-1835-4515 ; 0000-0001-8790-4026 ; 0000-0003-2533-3373</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,776,780,27901,27902</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/34369052$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Pincus, Kathleen J.</creatorcontrib><creatorcontrib>Blackman, Alison L.</creatorcontrib><creatorcontrib>Suen, Samuel Y.</creatorcontrib><creatorcontrib>Devabhakthuni, Sandeep</creatorcontrib><creatorcontrib>Gale, Stormi</creatorcontrib><creatorcontrib>Noel, Zachary R.</creatorcontrib><creatorcontrib>Seung, Hyunuk</creatorcontrib><creatorcontrib>Pandit, Neha Sheth</creatorcontrib><title>Statin gap in patients living with HIV: assessing dose appropriateness</title><title>HIV medicine</title><addtitle>HIV Med</addtitle><description>Objectives
Patients living with HIV (PLWH) are predisposed to atherosclerotic cardiovascular disease (ASCVD), resulting in concomitant antiretroviral and statin use. A statin prescribing gap for PLWH has been reported, but appropriateness of statin selection and dosing (ASD) has not been described.
Methods
This is a comparative, retrospective study reviewing ASD in PLWH vs. uninfected patients at two outpatient clinics within an academic medical centre. Adults > 21 years old indicated for statin therapy were included. The primary outcome was percentage of PLWH prescribed an appropriately dosed statin, accounting for clinical‐ and patient‐related variables, compared with uninfected patients. The secondary outcome was to identify patient characteristics associated with inappropriately dosed statins.
Results
After propensity score matching, 879 PLWH and 879 uninfected patients were included for analysis. Fewer PLWH (27.8%, n = 244) were prescribed an ASD compared with uninfected patients (40.5%, n = 356, P < 0.001). Similar rates of statin omission were seen in both populations (P = 0.11). More PLWH received too low a dose compared with the uninfected population (P < 0.0064). There were lower ASD rates in PLWH for subgroups of patients with clinical ASCVD (P = 0.00013) and 10‐year ASCVD risk ≥7.5% (P = 0.00055), but not in patients with low‐density lipoprotein cholesterol ≥190 mg/dL or diabetes.
Conclusions
Although a statin gap exists in both PLWH and uninfected patients, the clinical significance may be greater for PLWH given the increased risk of ASCVD. This study confirms a larger statin gap in PLWH, particularly when underdosing of statin medications is considered. Additional analysis is warranted to investigate reasons for the ASD gap and beneficial clinical interventions.</description><subject>Adult</subject><subject>Antiretroviral agents</subject><subject>Arteriosclerosis</subject><subject>Atherosclerosis</subject><subject>Atherosclerosis - drug therapy</subject><subject>atherosclerotic cardiovascular disease</subject><subject>Cardiovascular diseases</subject><subject>Cholesterol</subject><subject>Cholesterol, LDL</subject><subject>Diabetes mellitus</subject><subject>Dosage</subject><subject>Health care facilities</subject><subject>HIV</subject><subject>HIV Infections - complications</subject><subject>HIV Infections - drug therapy</subject><subject>Human immunodeficiency virus</subject><subject>Humans</subject><subject>Hydroxymethylglutaryl-CoA Reductase Inhibitors - therapeutic use</subject><subject>lipids</subject><subject>Patients</subject><subject>Retrospective Studies</subject><subject>Statins</subject><subject>Subgroups</subject><subject>Young Adult</subject><issn>1464-2662</issn><issn>1468-1293</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2021</creationdate><recordtype>article</recordtype><recordid>eNp1kF1LwzAUhoMobn5c-Aek4I1edMtH06beyXBuMPDCj9uQNsmW0bW16Tb27z1bpxeCIXCSw8ObkwehG4IHBNZw4TYDwgjHJ6hPoliEhKbs9HCOQhrHtIcuvF9iTBKW4nPUYxGLU8xpH43fWtW6MpirOoBSw8WUrQ8Kt3HlPNi6dhFMpp-PgfLeeL_v6cqbQNV1U9WNU60poX-FzqwqvLk-1kv0MX5-H03C2evLdPQ0C3PGGQ6FTWzOGLYaWwNb81hnGdFEkMhmSSpIKrTAIiECBjW5YtpmNIlEyjnNuGaX6L7Lhde_1sa3cuV8bopClaZae0k5T-OYxAkD9O4PuqzWTQnTASVYJCIqKFAPHZU3lfeNsRI-tVLNThIs93IlyJUHucDeHhPX2croX_LHJgDDDti6wuz-T5JgtIv8Bp_XgiA</recordid><startdate>202111</startdate><enddate>202111</enddate><creator>Pincus, Kathleen J.</creator><creator>Blackman, Alison L.</creator><creator>Suen, Samuel Y.</creator><creator>Devabhakthuni, Sandeep</creator><creator>Gale, Stormi</creator><creator>Noel, Zachary R.</creator><creator>Seung, Hyunuk</creator><creator>Pandit, Neha Sheth</creator><general>Wiley Subscription Services, Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7U7</scope><scope>7U9</scope><scope>C1K</scope><scope>H94</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0003-4446-5742</orcidid><orcidid>https://orcid.org/0000-0002-0957-8197</orcidid><orcidid>https://orcid.org/0000-0002-1835-4515</orcidid><orcidid>https://orcid.org/0000-0001-8790-4026</orcidid><orcidid>https://orcid.org/0000-0003-2533-3373</orcidid></search><sort><creationdate>202111</creationdate><title>Statin gap in patients living with HIV: assessing dose appropriateness</title><author>Pincus, Kathleen J. ; Blackman, Alison L. ; Suen, Samuel Y. ; Devabhakthuni, Sandeep ; Gale, Stormi ; Noel, Zachary R. ; Seung, Hyunuk ; Pandit, Neha Sheth</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c3530-8f7fc330fd0fe0fed56dbb1d1814fb798198d808718390eca3dfb27489552b5d3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2021</creationdate><topic>Adult</topic><topic>Antiretroviral agents</topic><topic>Arteriosclerosis</topic><topic>Atherosclerosis</topic><topic>Atherosclerosis - drug therapy</topic><topic>atherosclerotic cardiovascular disease</topic><topic>Cardiovascular diseases</topic><topic>Cholesterol</topic><topic>Cholesterol, LDL</topic><topic>Diabetes mellitus</topic><topic>Dosage</topic><topic>Health care facilities</topic><topic>HIV</topic><topic>HIV Infections - complications</topic><topic>HIV Infections - drug therapy</topic><topic>Human immunodeficiency virus</topic><topic>Humans</topic><topic>Hydroxymethylglutaryl-CoA Reductase Inhibitors - therapeutic use</topic><topic>lipids</topic><topic>Patients</topic><topic>Retrospective Studies</topic><topic>Statins</topic><topic>Subgroups</topic><topic>Young Adult</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Pincus, Kathleen J.</creatorcontrib><creatorcontrib>Blackman, Alison L.</creatorcontrib><creatorcontrib>Suen, Samuel Y.</creatorcontrib><creatorcontrib>Devabhakthuni, Sandeep</creatorcontrib><creatorcontrib>Gale, Stormi</creatorcontrib><creatorcontrib>Noel, Zachary R.</creatorcontrib><creatorcontrib>Seung, Hyunuk</creatorcontrib><creatorcontrib>Pandit, Neha Sheth</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Toxicology Abstracts</collection><collection>Virology and AIDS Abstracts</collection><collection>Environmental Sciences and Pollution Management</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>MEDLINE - Academic</collection><jtitle>HIV medicine</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Pincus, Kathleen J.</au><au>Blackman, Alison L.</au><au>Suen, Samuel Y.</au><au>Devabhakthuni, Sandeep</au><au>Gale, Stormi</au><au>Noel, Zachary R.</au><au>Seung, Hyunuk</au><au>Pandit, Neha Sheth</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Statin gap in patients living with HIV: assessing dose appropriateness</atitle><jtitle>HIV medicine</jtitle><addtitle>HIV Med</addtitle><date>2021-11</date><risdate>2021</risdate><volume>22</volume><issue>10</issue><spage>917</spage><epage>923</epage><pages>917-923</pages><issn>1464-2662</issn><eissn>1468-1293</eissn><abstract>Objectives
Patients living with HIV (PLWH) are predisposed to atherosclerotic cardiovascular disease (ASCVD), resulting in concomitant antiretroviral and statin use. A statin prescribing gap for PLWH has been reported, but appropriateness of statin selection and dosing (ASD) has not been described.
Methods
This is a comparative, retrospective study reviewing ASD in PLWH vs. uninfected patients at two outpatient clinics within an academic medical centre. Adults > 21 years old indicated for statin therapy were included. The primary outcome was percentage of PLWH prescribed an appropriately dosed statin, accounting for clinical‐ and patient‐related variables, compared with uninfected patients. The secondary outcome was to identify patient characteristics associated with inappropriately dosed statins.
Results
After propensity score matching, 879 PLWH and 879 uninfected patients were included for analysis. Fewer PLWH (27.8%, n = 244) were prescribed an ASD compared with uninfected patients (40.5%, n = 356, P < 0.001). Similar rates of statin omission were seen in both populations (P = 0.11). More PLWH received too low a dose compared with the uninfected population (P < 0.0064). There were lower ASD rates in PLWH for subgroups of patients with clinical ASCVD (P = 0.00013) and 10‐year ASCVD risk ≥7.5% (P = 0.00055), but not in patients with low‐density lipoprotein cholesterol ≥190 mg/dL or diabetes.
Conclusions
Although a statin gap exists in both PLWH and uninfected patients, the clinical significance may be greater for PLWH given the increased risk of ASCVD. This study confirms a larger statin gap in PLWH, particularly when underdosing of statin medications is considered. Additional analysis is warranted to investigate reasons for the ASD gap and beneficial clinical interventions.</abstract><cop>England</cop><pub>Wiley Subscription Services, Inc</pub><pmid>34369052</pmid><doi>10.1111/hiv.13150</doi><tpages>7</tpages><orcidid>https://orcid.org/0000-0003-4446-5742</orcidid><orcidid>https://orcid.org/0000-0002-0957-8197</orcidid><orcidid>https://orcid.org/0000-0002-1835-4515</orcidid><orcidid>https://orcid.org/0000-0001-8790-4026</orcidid><orcidid>https://orcid.org/0000-0003-2533-3373</orcidid></addata></record> |
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| ispartof | HIV medicine, 2021-11, Vol.22 (10), p.917-923 |
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| source | Wiley |
| subjects | Adult Antiretroviral agents Arteriosclerosis Atherosclerosis Atherosclerosis - drug therapy atherosclerotic cardiovascular disease Cardiovascular diseases Cholesterol Cholesterol, LDL Diabetes mellitus Dosage Health care facilities HIV HIV Infections - complications HIV Infections - drug therapy Human immunodeficiency virus Humans Hydroxymethylglutaryl-CoA Reductase Inhibitors - therapeutic use lipids Patients Retrospective Studies Statins Subgroups Young Adult |
| title | Statin gap in patients living with HIV: assessing dose appropriateness |
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