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Under 2% of San Franciscans With HIV
Have All 5 CVD Risk Factors Controlled
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IAS 2023, July 23-26, 2023. Brisbane
Mark Mascolini
Fewer than 1 in 50 San Francisco residents with HIV and without existing atherosclerotic cardiovascular disease (ASCVD) had 5 of 5 CVD risk factors under control, according to analysis of 2567 nonhospitalized people [1]. University of California San Francisco (UCSF) researchers who conducted this study chalked up the worst cardiovascular health marks for nicotine use and blood pressure control.
Although people with HIV run a heightened risk of ASCVD, prior research shows that most have not discussed cardiovascular risk with their clinician, and measures that promote heart health in the general population often get overlooked or ignored in the HIV clinic. To get a better look at ASCVD awareness and countermeasures in an ambulatory HIV population, Megan McLaughlin and colleagues in Priscilla Hsue’s UCSF group assessed ASCVD screening, treatment, and control in these people and cardiovascular health as defined by the American Heart Association.
This retrospective study relied on ICD-10 codes to tally ASCVD-related conditions while scouring electronic medical records for other relevant data. The analysis involved 2567 people with HIV who were at least 40 years old, had no record of ASCVD, and received care at one of three San Francisco clinics in 2019-2022. The group had a median age of 55 (interquartile range [IQR] 48 to 61), 86% were men, 24% Hispanic, and 18% black. A big majority, 95%, took antiretroviral therapy, 84% had an undetectable viral load, and median CD4 count stood at 530.
Median 10-year ASCVD risk measured 7.6% (IQR 3.7 to 13.2). People using Medicare (65 or older), blacks, people with sleep apnea, and those with chronic kidney disease had lower cardiovascular health scores. People with an undetectable viral load had higher scores.
Although 77% of the group had complete ASCVD risk factor assessment, many of their clinicians fell short in taking standard steps to maintain or improve heart health. Hypertension screening of almost everyone in the cohort showed that 69% had high blood pressure, but clinicians prescribed antihypertensives for only 39% of people with hypertension. Most study group members, 87%, had cholesterol screening and 43% were eligible for statins. But only 19% took a statin and only 47% had cholesterol under the non-HDL target of 130 mg/dL.
Focusing on the 5 components of the cardiovascular health score, the UCSF team recorded scores of 55.1 (out of 100) for nicotine use, 71.3 for body mass index, 70.4 for lipids, 81.2 for glucose, and 56.0 for blood pressure. Compared with the general population, this HIV group had worse scores for nicotine uses (55.1 vs 69.2) and blood pressure (56.0 vs 70.8). A mere 1.4% of these people with HIV had all 5 risk factors under control, while 72% had 2 or fewer risk factors controlled.
Taken together, if these findings are typical of HIV populations elsewhere, people with HIV and their clinicians have lots of room for improvement on the road to heart health.
Reference
1. McLaughlin MM, Durstenfeld MS, Beatty AL, Hsue PY. Cardiovascular health among persons with HIV without existing atherosclerotic cardiovascular disease. IAS 2023, July 23-26, 2023. Brisbane. Abstract EPB0167.
IAS: Cardiovascular health among persons with HIV without existing atherosclerotic cardiovascular disease: low statin 44% & anti-hypertensives 39% use among eligible - poor control of risk factors. - (07/25/23)
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