HIV patients less likely to be prescribed aspirin, statins despite increased cardiovascular risk

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People with HIV and risk factors for heart disease and stroke are less likely to receive prescriptions for statins and aspirin than those without HIV, according to a study in the Journal of the American Heart Association.

Researchers analyzed survey data from a nationally representative sample of both HIV-infected and HIV-uninfected patients aged 40 to 79 from 2006 to 2013. They identified 1,631 physician visits by HIV-positive patients and 226,862 visits by HIV-negative patients.

HIV patients were prescribed aspirin/antiplatelet therapy less often (5.1 versus 13.8 percent) and were given statin therapy in the presence of diabetes, cardiovascular disease or dyslipidemia less often (23.6 percent versus 35.8 percent).

“U.S. physicians generally underused guideline‐recommended cardiovascular care for high‐risk patients, and were less likely to prescribe aspirin and statins to HIV‐infected patients at increased risk—findings that may partially explain higher rates of adverse cardiovascular events among patients with HIV,” wrote the UCLA-based researchers, including first author Joseph A. Ladapo, MD, PhD. “Professional guidelines, practice‐level, or reimbursement‐based policy changes that focus on quality of care among patients with HIV will be needed to ameliorate these disparities and reduce HIV‐related cardiovascular morbidity and mortality.”

Ladapo and colleagues pointed out statins and aspirins have consistently been shown to be cost-effective while reducing adverse cardiovascular events in at-risk populations. The HIV population is at a 50 to 100 percent increased risk of MI and stroke compared to those without HIV, the researchers noted, and more than a quarter of the 1.2 million Americans living with the virus are 55 and older.

“While differences in other risk factors, particularly the substantial differences in smoking and HIV‐related inflammation, likely play a larger role” in cardiovascular event rates, Ladapo et al. wrote, “the differences in aspirin and statin prescription rates represent a target for quality improvement efforts.”

In the study, HIV-positive patients were also less likely to receive antihypertensive medication, diet or exercise counseling and smoking cessation advice or therapy, although the differences in those categories didn’t reach statistical significance. In fact, the researchers noted a decline in those counseling-type interventions across both sets of patients.

“These concerning declines in evidence‐based behavioral counseling may be attributable to a ‘crowd out’ effect from an increase in the number of competing clinical items addressed during ambulatory visits,” they wrote.

Compared to patients without HIV, patients with HIV were more likely to be younger, male, Hispanic, black and uninsured or insured by Medicaid.

Ladapo and colleagues noted they couldn’t analyze the differences in treatment based on insurance coverage or income due to a lack of sample size. In addition, they weren’t able to account for blood pressure or cholesterol levels because the surveys provided a limited amount of clinical information on each patient.