Low-density lipoprotein cholesterol response after statin initiation among persons living with human immunodeficiency virus

Greer A. Burkholder, Paul Muntner, Hong Zhao, Michael J. Mugavero, E. Turner Overton, Meredith Kilgore, Daniel R. Drozd, Heidi M. Crane, Richard D Moore, Wm Christopher Mathews, Elvin Geng, Stephen Boswell, Michelle Floris-Moore, Robert S. Rosenson

Research output: Contribution to journalArticle

Abstract

Background: Meta-analyses of general population studies report mean low-density lipoprotein cholesterol (LDL-C) reductions of 30% to <50% with moderate-intensity and ≥50% with high-intensity statins. Persons living with human immunodeficiency virus (PLWH) are at high risk for atherosclerotic cardiovascular disease (ASCVD), yet many have elevated LDL-C. Objective: To evaluate LDL-C response after statin initiation among PLWH. Methods: We conducted a retrospective cohort study of PLWH initiating statins between 2009 and 2013 (N = 706). Patients were categorized into mutually exclusive groups in the following hierarchy: history of coronary heart disease (CHD), diabetes, prestatin LDL-C ≥190 mg/dL, 10-year predicted ASCVD risk ≥7.5%, and none of the above (ie, unknown statin indication). The primary outcome was a ≥30% reduction in LDL-C after statin initiation. Results: Among patients initiating statins, 5.8% had a history of CHD, 13.6% had diabetes, 6.2% had LDL-C ≥190 mg/dL, 35.4% had 10-year ASCVD risk ≥7.5%, and 39.0% had an unknown statin indication. Among patients with a history of CHD, 31.7% achieved a ≥30% LDL-C reduction compared with 25.0%, 59.1%, and 33.9% among those with diabetes, LDL-C ≥190 mg/dL, and 10-year ASCVD risk ≥7.5%, respectively. In multivariable adjusted analyses and compared to patients with an unknown statin indication, LDL-C ≥ 190 mg/dL was associated with a prevalence ratio for an LDL-C reduction ≥30% of 1.81 (95% confidence interval, 1.34–2.45), whereas no statistically significant association was present for history of CHD, diabetes, and 10-year ASCVD risk ≥7.5%. Conclusion: A low percentage of PLWH achieved the expected reductions in LDL-C after statin initiation, highlighting an unmet need for ASCVD risk reduction.

Original languageEnglish (US)
JournalJournal of Clinical Lipidology
DOIs
StateAccepted/In press - Jan 1 2018

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Hydroxymethylglutaryl-CoA Reductase Inhibitors
LDL Cholesterol
HIV
Cardiovascular Diseases
Coronary Disease
Risk Reduction Behavior
Meta-Analysis
Cohort Studies
Retrospective Studies
Confidence Intervals

Keywords

  • Cardiovascular disease
  • Dyslipidemia
  • HIV infection
  • Low-density lipoprotein cholesterol
  • Statin

ASJC Scopus subject areas

  • Internal Medicine
  • Endocrinology, Diabetes and Metabolism
  • Nutrition and Dietetics
  • Cardiology and Cardiovascular Medicine

Cite this

Burkholder, G. A., Muntner, P., Zhao, H., Mugavero, M. J., Overton, E. T., Kilgore, M., ... Rosenson, R. S. (Accepted/In press). Low-density lipoprotein cholesterol response after statin initiation among persons living with human immunodeficiency virus. Journal of Clinical Lipidology. https://doi.org/10.1016/j.jacl.2018.03.082

Low-density lipoprotein cholesterol response after statin initiation among persons living with human immunodeficiency virus. / Burkholder, Greer A.; Muntner, Paul; Zhao, Hong; Mugavero, Michael J.; Overton, E. Turner; Kilgore, Meredith; Drozd, Daniel R.; Crane, Heidi M.; Moore, Richard D; Mathews, Wm Christopher; Geng, Elvin; Boswell, Stephen; Floris-Moore, Michelle; Rosenson, Robert S.

In: Journal of Clinical Lipidology, 01.01.2018.

Research output: Contribution to journalArticle

Burkholder, GA, Muntner, P, Zhao, H, Mugavero, MJ, Overton, ET, Kilgore, M, Drozd, DR, Crane, HM, Moore, RD, Mathews, WC, Geng, E, Boswell, S, Floris-Moore, M & Rosenson, RS 2018, 'Low-density lipoprotein cholesterol response after statin initiation among persons living with human immunodeficiency virus', Journal of Clinical Lipidology. https://doi.org/10.1016/j.jacl.2018.03.082
Burkholder, Greer A. ; Muntner, Paul ; Zhao, Hong ; Mugavero, Michael J. ; Overton, E. Turner ; Kilgore, Meredith ; Drozd, Daniel R. ; Crane, Heidi M. ; Moore, Richard D ; Mathews, Wm Christopher ; Geng, Elvin ; Boswell, Stephen ; Floris-Moore, Michelle ; Rosenson, Robert S. / Low-density lipoprotein cholesterol response after statin initiation among persons living with human immunodeficiency virus. In: Journal of Clinical Lipidology. 2018.
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abstract = "Background: Meta-analyses of general population studies report mean low-density lipoprotein cholesterol (LDL-C) reductions of 30{\%} to <50{\%} with moderate-intensity and ≥50{\%} with high-intensity statins. Persons living with human immunodeficiency virus (PLWH) are at high risk for atherosclerotic cardiovascular disease (ASCVD), yet many have elevated LDL-C. Objective: To evaluate LDL-C response after statin initiation among PLWH. Methods: We conducted a retrospective cohort study of PLWH initiating statins between 2009 and 2013 (N = 706). Patients were categorized into mutually exclusive groups in the following hierarchy: history of coronary heart disease (CHD), diabetes, prestatin LDL-C ≥190 mg/dL, 10-year predicted ASCVD risk ≥7.5{\%}, and none of the above (ie, unknown statin indication). The primary outcome was a ≥30{\%} reduction in LDL-C after statin initiation. Results: Among patients initiating statins, 5.8{\%} had a history of CHD, 13.6{\%} had diabetes, 6.2{\%} had LDL-C ≥190 mg/dL, 35.4{\%} had 10-year ASCVD risk ≥7.5{\%}, and 39.0{\%} had an unknown statin indication. Among patients with a history of CHD, 31.7{\%} achieved a ≥30{\%} LDL-C reduction compared with 25.0{\%}, 59.1{\%}, and 33.9{\%} among those with diabetes, LDL-C ≥190 mg/dL, and 10-year ASCVD risk ≥7.5{\%}, respectively. In multivariable adjusted analyses and compared to patients with an unknown statin indication, LDL-C ≥ 190 mg/dL was associated with a prevalence ratio for an LDL-C reduction ≥30{\%} of 1.81 (95{\%} confidence interval, 1.34–2.45), whereas no statistically significant association was present for history of CHD, diabetes, and 10-year ASCVD risk ≥7.5{\%}. Conclusion: A low percentage of PLWH achieved the expected reductions in LDL-C after statin initiation, highlighting an unmet need for ASCVD risk reduction.",
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AU - Burkholder, Greer A.

AU - Muntner, Paul

AU - Zhao, Hong

AU - Mugavero, Michael J.

AU - Overton, E. Turner

AU - Kilgore, Meredith

AU - Drozd, Daniel R.

AU - Crane, Heidi M.

AU - Moore, Richard D

AU - Mathews, Wm Christopher

AU - Geng, Elvin

AU - Boswell, Stephen

AU - Floris-Moore, Michelle

AU - Rosenson, Robert S.

PY - 2018/1/1

Y1 - 2018/1/1

N2 - Background: Meta-analyses of general population studies report mean low-density lipoprotein cholesterol (LDL-C) reductions of 30% to <50% with moderate-intensity and ≥50% with high-intensity statins. Persons living with human immunodeficiency virus (PLWH) are at high risk for atherosclerotic cardiovascular disease (ASCVD), yet many have elevated LDL-C. Objective: To evaluate LDL-C response after statin initiation among PLWH. Methods: We conducted a retrospective cohort study of PLWH initiating statins between 2009 and 2013 (N = 706). Patients were categorized into mutually exclusive groups in the following hierarchy: history of coronary heart disease (CHD), diabetes, prestatin LDL-C ≥190 mg/dL, 10-year predicted ASCVD risk ≥7.5%, and none of the above (ie, unknown statin indication). The primary outcome was a ≥30% reduction in LDL-C after statin initiation. Results: Among patients initiating statins, 5.8% had a history of CHD, 13.6% had diabetes, 6.2% had LDL-C ≥190 mg/dL, 35.4% had 10-year ASCVD risk ≥7.5%, and 39.0% had an unknown statin indication. Among patients with a history of CHD, 31.7% achieved a ≥30% LDL-C reduction compared with 25.0%, 59.1%, and 33.9% among those with diabetes, LDL-C ≥190 mg/dL, and 10-year ASCVD risk ≥7.5%, respectively. In multivariable adjusted analyses and compared to patients with an unknown statin indication, LDL-C ≥ 190 mg/dL was associated with a prevalence ratio for an LDL-C reduction ≥30% of 1.81 (95% confidence interval, 1.34–2.45), whereas no statistically significant association was present for history of CHD, diabetes, and 10-year ASCVD risk ≥7.5%. Conclusion: A low percentage of PLWH achieved the expected reductions in LDL-C after statin initiation, highlighting an unmet need for ASCVD risk reduction.

AB - Background: Meta-analyses of general population studies report mean low-density lipoprotein cholesterol (LDL-C) reductions of 30% to <50% with moderate-intensity and ≥50% with high-intensity statins. Persons living with human immunodeficiency virus (PLWH) are at high risk for atherosclerotic cardiovascular disease (ASCVD), yet many have elevated LDL-C. Objective: To evaluate LDL-C response after statin initiation among PLWH. Methods: We conducted a retrospective cohort study of PLWH initiating statins between 2009 and 2013 (N = 706). Patients were categorized into mutually exclusive groups in the following hierarchy: history of coronary heart disease (CHD), diabetes, prestatin LDL-C ≥190 mg/dL, 10-year predicted ASCVD risk ≥7.5%, and none of the above (ie, unknown statin indication). The primary outcome was a ≥30% reduction in LDL-C after statin initiation. Results: Among patients initiating statins, 5.8% had a history of CHD, 13.6% had diabetes, 6.2% had LDL-C ≥190 mg/dL, 35.4% had 10-year ASCVD risk ≥7.5%, and 39.0% had an unknown statin indication. Among patients with a history of CHD, 31.7% achieved a ≥30% LDL-C reduction compared with 25.0%, 59.1%, and 33.9% among those with diabetes, LDL-C ≥190 mg/dL, and 10-year ASCVD risk ≥7.5%, respectively. In multivariable adjusted analyses and compared to patients with an unknown statin indication, LDL-C ≥ 190 mg/dL was associated with a prevalence ratio for an LDL-C reduction ≥30% of 1.81 (95% confidence interval, 1.34–2.45), whereas no statistically significant association was present for history of CHD, diabetes, and 10-year ASCVD risk ≥7.5%. Conclusion: A low percentage of PLWH achieved the expected reductions in LDL-C after statin initiation, highlighting an unmet need for ASCVD risk reduction.

KW - Cardiovascular disease

KW - Dyslipidemia

KW - HIV infection

KW - Low-density lipoprotein cholesterol

KW - Statin

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