480. Prescription of Aspirin for Primary Prevention of Cardiovascular Disease in HIV-Infected Patients
Session: Poster Abstract Session: HIV Primary Care
Friday, October 21, 2011
Room: Poster Hall B1
Handouts
  • Burkholder_IDSA poster.pdf (221.3 kB)
  • Background: Due to the dramatic impact of antiretroviral therapy on survival, cardiovascular disease (CVD) is an increasing threat in the aging HIV-infected population.  The 2009 U.S. Preventive Services Task Force (USPSTF) guidelines recommend aspirin (ASA) for primary prevention of myocardial infarction in men age ≥45 and of ischemic stroke in women age ≥ 55.  Data on HIV provider practices regarding ASA for primary prevention of CVD is lacking.

    Methods:  A cross-sectional study at the UAB 1917 HIV/AIDS Clinic Cohort evaluated frequency of ASA prescription in men age 45-79 and women age 55-79 without known CVD (i.e. requiring ASA for secondary prophylaxis) or contraindication to ASA. Patients with ≥1 primary HIV provider visit during the study period (12/12/09-12/11/10) who had attended ≥1 clinic visit the preceding year were included (established clinic patients).  Multivariable (MV) logistic regression models were used to evaluate associations of socio-demographic, biomedical and psychosocial factors with ASA prescription. 

    Results:  Of 1,882 active patients, 397 were eligible for ASA prescription per USPSTF guidelines (mean age 52.3, 94% male, 36% African American); only 66 (17%) were prescribed ASA.  High prevalence of CVD risk factors was observed: 55% hypertension (HTN); 16% diabetes mellitus (DM); 63% hyperlipidemia (HLD); 39% current smokers; 55% overweight/obese.   In MV analysis, DM (OR=2.6; 95% CI 1.3-5.3; p<0.01), HLD (3.4; 1.6-7.6; p<0.01) and smoking (1.9; 1.0-3.4; p=0.04) were significantly associated with ASA prescription, whereas age, gender, race, HTN, obesity, CD4 count and duration of care were not. In MV analysis evaluating CVD-related co-morbidities (DM, HLD, smoking, HTN) as a count measure, each additional co-morbidity increased odds of ASA prescription by 2.1 (1.5-3.0; p<0.01).

    Conclusion:  Fewer than 20% of HIV-infected patients meeting USPSTF criteria for primary prevention of CVD were prescribed ASA.  While traditional risk factors such as DM, HLD and smoking significantly increased the likelihood of ASA prescription, presence of multiple co-morbidities was often required to trigger prescription.  Strategies to encourage more aggressive risk assessment and intervention are needed.  


    Subject Category: H. HIV/AIDS and other retroviruses

    Greer A. Burkholder, MD, Ashutosh Tamhane, MD, MSPH, Jorge Luis Salinas, MD, Michael J. Mugavero, MD, MHSc, James H. Willig, MD, MSPH, Andrew O. Westfall, MS and Michael S. Saag, MD, FIDSA, University of Alabama at Birmingham, Birmingham, AL

    Disclosures:

    G. A. Burkholder, Bristol-Myers Squibb: Virology Research Trainee, Research grant
    NRSA: trainee, Educational support and Research grant

    A. Tamhane, None

    J. L. Salinas, None

    M. J. Mugavero, Bristol-Myers Squibb: Grant Investigator and Scientific Advisor, Consulting fee and Research grant
    Gilead Sciences: Research Contractor and Scientific Advisor, Consulting fee
    Tibotec Therapeutics: Grant Investigator, Research grant
    Pfizer: Grant Investigator, Research grant
    Definicare: Grant Investigator, Research grant

    J. H. Willig, Bristol-Myers Squibb: Grant Investigator, Research grant and Research support
    Definicare: Grant Investigator, Research grant
    Gilead: Grant Investigator, Research support
    Pfizer: Grant Investigator, Research support

    A. O. Westfall, Definicare: Grant Investigator, Research grant
    Bristol-Myers Squibb: Grant Investigator, Research grant
    Gilead: Grant Investigator, Research grant

    M. S. Saag, Merck: Consultant and Scientific Advisor, Consulting fee
    Adrea Biosciences: Consultant and Scientific Advisor, Consulting fee
    Boehringer: Consultant and Scientific Advisor, Consulting fee
    Ingelheim: Consultant and Scientific Advisor, Consulting fee
    Bristol-Myers Squibb: Consultant and Scientific Advisor, Consulting fee
    Gilead: Consultant and Scientific Advisor, Consulting fee
    GSK: Consultant and Scientific Advisor, Consulting fee
    Pfizer: Consultant and Scientific Advisor, Consulting fee
    Vliv: Consultant and Scientific Advisor, Consulting fee
    Tibotec: Consultant and Scientific Advisor, Consulting fee
    Vertex: Scientific Advisor, Consulting fee
    Monogram Biosciences: Research Contractor, Research support
    NIH/NIAID: Grant Investigator, Grant recipient

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    Findings in the abstracts are embargoed until 12:01 a.m. EST Thursday, Oct. 20 with the exception of research findings presented at IDSA press conferences.