Prevalence of Subclinical Atherosclerosis and Risk of Atherosclerotic Cardiovascular Disease in Older Adults Living with HIV

Background: Recent studies suggest that statins are underprescribed in patients living with HIV (PLWH) at risk for atherosclerotic cardiovascular disease (ASCVD), but none have assessed if eligible patients receive the correct statin and intensity compared to uninfected controls. Objectives: The primary objective was to determine whether statin-eligible PLWH are less likely to receive appropriate statin therapy compared to patients without HIV. Methods: This retrospective study evaluated statin eligibility and prescribing among patients in both an HIV and internal medicine clinic at an urban, academic medical center from June-September 2018 using the American College of Cardiology/American Heart Association guideline on treating blood cholesterol to reduce ASCVD risk. Patients were assessed for eligibility and actual treatment with appropriate statin therapy. Characteristics of patients appropriately and not appropriately treated were compared with chi-square testing and predictors for receiving appropriate statin therapy were determined with logistic regression. Results: A total of 221/300 study subjects were statin-eligible. Fewer statin-eligible PLWH were receiving the correct statin intensity for their risk benefit group versus the uninfected control group (30.2% vs 67.0%, p < 0.001). In the multivariable logistic regression analysis, PLWH were significantly less likely to receive appropriate statin therapy, while those with polypharmacy were more likely to receive appropriate statin therapy. Conclusion: Our study reveals that PLWH may be at a disadvantage in receiving appropriate statin therapy for ASCVD risk reduction. This is important given the heightened risk for ASCVD in this population, and strategies that address this gap in care should be explored.

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Statin Use in Older Adults with Stable Atherosclerotic Cardiovascular Disease

Journal of the American Geriatrics Society ◽

10.1111/jgs.16975 ◽

2021 ◽

Author(s):

Gabriela Spencer‐Bonilla ◽

Sukyung Chung ◽

Ashish Sarraju ◽

Paul Heidenreich ◽

Latha Palaniappan ◽

...

Keyword(s):

Cardiovascular Disease ◽

Older Adults ◽

Atherosclerotic Cardiovascular Disease ◽

Statin Use

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Global Burden of Atherosclerotic Cardiovascular Disease in People Living With HIV

Circulation ◽

10.1161/circulationaha.117.033369 ◽

2018 ◽

Vol 138 (11) ◽

pp. 1100-1112 ◽

Cited By ~ 144

Author(s):

Anoop S.V. Shah ◽

Dominik Stelzle ◽

Kuan Ken Lee ◽

Eduard J. Beck ◽

Shirjel Alam ◽

...

Keyword(s):

Cardiovascular Disease ◽

Global Burden ◽

People Living With Hiv ◽

Atherosclerotic Cardiovascular Disease ◽

Living With Hiv

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Inorganic nitrate supplementation attenuates conduit artery retrograde and oscillatory shear in older adults

AJP Heart and Circulatory Physiology ◽

10.1152/ajpheart.00843.2020 ◽

2021 ◽

Vol 320 (3) ◽

pp. H991-H998

Author(s):

Darren P. Casey ◽

Joshua M. Bock

Keyword(s):

Cardiovascular Disease ◽

Older Adults ◽

Brachial Artery ◽

Oscillatory Shear ◽

Atherosclerotic Cardiovascular Disease ◽

Conduit Artery ◽

Inorganic Nitrate ◽

Nitrate Supplementation ◽

First Time

We report for the first time, to our knowledge, that 4 wk of inorganic nitrate supplementation attenuates retrograde and oscillatory shear in the brachial artery of older adults. However, this was not associated with greater hyperemic or vasodilatory responses to exercise. In sum, these data highlight favorable changes in shear patterns with aging, which may reduce the risk of atherosclerotic cardiovascular disease.

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Treating Dyslipidemias in the Primary Prevention of Atherosclerotic Cardiovascular Disease in Older Adults with Diabetes Mellitus

Clinics in Geriatric Medicine ◽

10.1016/j.cger.2020.04.006 ◽

2020 ◽

Vol 36 (3) ◽

pp. 457-476

Author(s):

MengHee Tan ◽

Mark Paul MacEachern

Keyword(s):

Diabetes Mellitus ◽

Cardiovascular Disease ◽

Older Adults ◽

Primary Prevention ◽

Atherosclerotic Cardiovascular Disease

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338. Patients Living with HIV Infection Are Less Likely to Receive the Correct Intensity of Statin Therapy for Cardiovascular Disease Risk Reduction

Open Forum Infectious Diseases ◽

10.1093/ofid/ofz360.411 ◽

2019 ◽

Vol 6 (Supplement_2) ◽

pp. S179-S180

Author(s):

Jason J Schafer ◽

Roshni Patel ◽

Nicholas V Hastain ◽

Todd Miano

Keyword(s):

Cardiovascular Disease ◽

Statin Therapy ◽

Risk Reduction ◽

Univariate Analysis ◽

Blood Cholesterol ◽

Atherosclerotic Cardiovascular Disease ◽

Lipid Panel ◽

Ascvd Risk ◽

Living With Hiv ◽

To Receive

Abstract Background Patients living with HIV (PLWH) at risk for atherosclerotic cardiovascular disease (ASCVD) should receive risk reduction interventions recommended in current guidelines. This includes routine ASCVD risk assessments and when eligible, statins selected and dosed to achieve appropriate low-density lipoprotein cholesterol (LDL-C) reduction. Recent studies suggest that statins are underprescribed in PLWH, but none have assessed if eligible patients receive the correct statin intensity compared with uninfected controls. Methods This retrospective study evaluated statin eligibility and prescribing among consecutive patients in an HIV clinic and an internal medicine clinic at an urban, academic medical center from June-September 2018. To determine statin eligibility, the 2013 American College of Cardiology/American Heart Association guideline on treating blood cholesterol to reduce ASCVD risk was used. Patients aged 40–75 that had a lipid panel obtained within the last year were included. All patients were assessed to determine eligibility for and actual treatment with appropriate statin therapy. Characteristics of patients correctly and incorrectly treated with statins were compared with chi-square testing and predictors for receiving correct statin therapy were determined with logistic multivariable regression. Results A total of 221/300 study subjects were statin eligible (Table 1). While many eligible PLWH were receiving a statin (54/106), considerably fewer were on the correct statin intensity for their benefit group (33/106). In the univariate analysis (Table 2), correctly treated patients were less likely to be PLWH or female, and were more likely to have polypharmacy and hypertension. In the multivariable logistic regression analysis (Table 3), PLWH (OR 0.26, CI95 0.12–0.57)) were significantly less likely to receive correct statin therapy, while those with concomitant polypharmacy were significantly more likely to receive correct statin therapy (OR 5.52, CI95 1.94, 15.69). Conclusion This study reveals that PLWH may be at a substantial disadvantage in terms of receiving correct statin therapy for ASCVD risk reduction. This finding may be particularly important given the heightened risk for ASCVD in this patient population. Disclosures All authors: No reported disclosures.

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Longitudinal Measures of Trimethylamine N-oxide and Incident Atherosclerotic Cardiovascular Disease Events in Older Adults: The Cardiovascular Health Study

Current Developments in Nutrition ◽

10.1093/cdn/nzaa061_062 ◽

2020 ◽

Vol 4 (Supplement_2) ◽

pp. 1434-1434

Author(s):

Yujin Lee ◽

Zeneng Wang ◽

Heidi Lai ◽

Marcia de Oliveira Otto ◽

Rozenn Lemaitre ◽

...

Keyword(s):

Cardiovascular Disease ◽

Older Adults ◽

Renal Function ◽

Cystatin C ◽

Impaired Renal Function ◽

Cardiovascular Health ◽

Health Study ◽

Cardiovascular Health Study ◽

Atherosclerotic Cardiovascular Disease ◽

Community Based

Abstract Objectives Trimethylamine N-oxide (TMAO) is a gut microbiota-dependent metabolite of dietary choline, L-carnitine and phosphatidylcholine-rich animal foods. Based on experimental studies and cohorts with prevalent disease, elevated TMAO may increase risk of atherosclerotic cardiovascular disease (ASCVD). TMAO is also renally cleared and may interact with and causally contribute to renal dysfunction and elevated cystatin-C. Yet, the associations of serial TMAO levels with incident ASCVD in a community-based prospective cohort, and the potential mediating and modifying role of renal function, are not established. Methods We investigated the associations of serial measures of plasma TMAO, assessed at baseline and 7 years post baseline, with incident ASCVD among 4144 older adults in the Cardiovascular Health Study (CHS). TMAO was measured using stable isotope dilution LC/MS/MS (lab CV <6%). Incident ASCVD (myocardial infarction, fatal coronary heart disease, stroke, sudden cardiac death, or other atherosclerotic death) was centrally adjudicated using medical records. Risk was assessed by multivariable Cox proportional hazards regression including time-varying demographics, lifestyle factors, medical history, and laboratory and dietary variables. We assessed potential mediating effects and interaction by renal function estimated by cystatin-C. Results During a median 15 years follow-up, 1757 ASCVD events occurred. After multivariable adjustment, TMAO was associated with a higher risk of ASCVD, with an extreme quintile HR (95% CI) of 1.22 (1.04, 1.44), P-trend = 0.01. This relationship appeared further mediated or confounded by estimated glomerular filtration rate (eGFR): adjusting for cystatin-C-based eGFR, the HR (95% CI) was 1.06 (0.98–1.25). Significant interaction was also observed by renal function (P-interaction < 0.001), with TMAO associated with higher risk of ASCVD among individuals with impaired renal function (eGFR ≤ 60) [1.63 (1.03–2.59)], but not normal baseline renal function (eGFR > 60) [1.15 (0.96–1.37)], even with further adjustment for continuous eGFR. Conclusions In this large community-based cohort of older US adults, higher serial measures of TMAO were associated with an elevated risk of ASCVD, in particular among those with impaired renal function. Funding Sources NIH, NHLBI.

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