2137. Optimizing Cardiovascular Risk Prevention in an Urban HIV Clinic
Session: Poster Abstract Session: HIV Cardiovascular Disease, Lipids, and Diabetes
Saturday, October 29, 2016
Room: Poster Hall
Posters
  • id week poster pdf.pdf (156.8 kB)
  • Background: Antiretroviral therapy (ART) treated HIV-infected patients have a 1.5-fold increased rate of cardiovascular (CV) events. The 2013 ACC/AHA guidelines recommend statin therapy for patients at high risk for CV disease including: history of atherosclerotic cardiovascular disease (ASCVD), LDL > 190 mg/dL, and 40-75 year olds with diabetes and LDL > 70. The 2011 AHA/ACCF guidelines recommend aspirin therapy for those with ASCVD. We evaluated the use of statin and aspirin therapy in HIV-infected patients with high CV risk in an urban HIV clinic.

    Methods: Using EPIC, we retrospectively reviewed data of adult HIV-infected patients who received primary care in a NYC HIV clinic during 7/1/14-6/30/15 who attended >2 primary care visits within the study period. We evaluated statin use in those with LDL >190 and diabetics with LDL > 70 and aspirin and statin use in those with ASCVD by ICD9 diagnosis. Detailed chart review was then performed to exclude erroneous coding and statin and aspirin intolerance.

    Results: 1150 patients were evaluated and 258 (22%) patients had high risk for CV disease by the criteria above. After detailed chart review 231 (20%) had high risk confirmed, of whom 86 (37.2%) were active cigarette smokers. 141/1150 (12.3%) had ASCVD, which was 141/231 (61%) of the high risk confirmed population. Of the 141 with ASCVD 79 (56%) were receiving statin therapy whereas 45 (31.9%) were not. 85/132 (64.4%) of diabetics had LDL >70 and of those 85, 48 (56.5%) were on statin therapy whereas 27 (31.8%) were not. Of the 141 ASCVD patients, 100 (70.9%) were receiving aspirin, while 17 (12%) were not.

    Conclusion: Statin therapy for ASCVD prevention needs to be optimized for HIV-infected patients, and there is a high rate of active tobacco smoking in this high risk population. It is unclear whether HIV-infected patients have similar CV risk to diabetic patients and should be treated with statin therapy for LDL > 70, and aspirin therapy for heightened 10-year CV risk score >10% (ADA guidelines for ASCVD primary prevention), however broadened statin and aspirin use for ASCVD prevention in HIV infection is actively being studied. These data highlight the need for comprehensive CV risk reduction programs in this vulnerable population.

    Emma Kaplan-Lewis, MD1, Judith Aberg, MD, FIDSA2 and Meagan O'brien, MD2, (1)Medicine- Infectious Diseases, Icahn School of Medicine at Mount Sinai, NY, NY, (2)Icahn school of medicine at mount sinai, ny, NY

    Disclosures:

    E. Kaplan-Lewis, None

    J. Aberg, None

    M. O'brien, None

    Findings in the abstracts are embargoed until 12:01 a.m. CDT, Wednesday Oct. 26th with the exception of research findings presented at the IDWeek press conferences.