HIV disease and therapy are associated with known metabolic complications and increased cardiovascular disease (CVD). Ethnic minorities are also often at increased risk for CVD. Dyslipidemia (DL) in HIV patients represents the major risk factor for CVD and stroke, and therefore, appropriate recognition and management is an essential aspect of preventative care. We explored the extent to which demographic factors are related to DL screening and the prevalence of DL among our HIV patients.
We conducted a retrospective review of our electronic medical record (EMR) to identify HIV patients seen at Henry Ford Hospital between March 2013 to November 2015. EMR abstraction both electronically and by direct chart review was performed to identify patients with DL screening and/or ICD-9 coding for DL. DL was defined based on the ATP III guidelines. Race/ethnicity and gender were described by self-report. Factors associated with DL screening and the presence of DL were evaluated.
A total of 1720 HIV patients were evaluated, mostly males (80.2 %), with a mean age of 47.8 years (+/- 13.0), and a mean BMI of 27.3 (+/- 9.3). The majority were African-American (AA) (68.3%) and White (27.2%), with < 5% other. DL testing was done at least once in 86% of patients (n=1480) and was more frequent in men than women, 87.3% vs. 81.2% (p=0.004), in patients with BMI > 26 (p=0.0006), and in older patients (48.8 vs. 41.5 years, p <0.001). Fewer AA patients were tested than White patients, 83.8% vs 91.6% (p-value <0.0001). The overall prevalence of DL after testing was 25.5%, with 20.9% of patients tested (n=310) developing DL after their HIV diagnosis. The prevalence of DL was lower in AA compared to Whites, 17.9% vs. 32.7% (p-value <0.001), but likelihood of treatment with lipid lowering drugs was lower for AA (57.5%) than Whites (66.6%) but not statistically significant (p= 0.086).
The majority of our HIV patients were tested at least once for dyslipidemia. However, gender, race, age and other gaps in lipid testing were identified that may place minorities and other subgroups with HIV at increased CVD risk due to missed opportunities for management of DL. Further research into the disparities in testing and strategies to improve lipid management are needed.
M. Mahan, None
J. Mckinnon, None