Dataset Information

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

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.

SUBMITTER: Burkholder GA

PROVIDER: S-EPMC9113294 | biostudies-literature | 2018 Jul - Aug

REPOSITORIES: biostudies-literature

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Publications

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

Burkholder Greer A GA Muntner Paul P Zhao Hong H Mugavero Michael J MJ Overton E Turner ET Kilgore Meredith M Drozd Daniel R DR Crane Heidi M HM Moore Richard D RD Mathews Wm Christopher WC Geng Elvin E Boswell Stephen S Floris-Moore Michelle M Rosenson Robert S RS

Journal of clinical lipidology 20180329 4

<h4>Background</h4>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.<h4>Objective</h4>To evaluate LDL-C response after statin initiation among PLWH.<h4>Methods</h4>We conducted a retrospective cohort study o ...[more]

PMID: 29853312

Similar Datasets

Project description:BackgroundRobust evidence is lacking on optimal timing of statin administration and its impact on patient outcomes.ObjectiveThis study aims to evaluate among incident statin users the relationship between those prescribed evening vs. daily dosing instructions, medication adherence, and changes in low-density lipoprotein cholesterol (LDL-c).DesignThis is an observational cohort study at Sutter Health, a community-based healthcare system, 2010-2016.ParticipantsPatients were ≥ 35 years of age as of the first statin prescription (baseline), with 12 to 36 months of electronic health record activity before and after baseline. Incident use was defined as no statin prescription in 12 months prior to baseline.Main measuresDifferences in medication adherence (proportion of days covered ≥ 0.80) over 12 months from baseline and mean change in LDL-c between 12 and 24 months from baseline were measured using regression modeling, adjusting for baseline demographics and clinical, prescriber, and statin characteristics.Key resultsAmong 31,252 patients with valid statin prescriptions between 2010 and 2016, 5099 eligible incident statin users (mean age, 63 years) were identified, of whom 53% were prescribed evening and 47% daily dosing instructions. No difference in likelihood of statin adherence over 12 months was observed for evening vs. daily dosing (adjusted odds ratio [OR] 0.90; 95% CI 0.75, 1.08). No differences were observed in mean change in LDL-c (adjusted mean difference 1.42 mg/dL; 95% CI - 1.02, 3.89) or likelihood of attaining LDL-c < 70 mg/dL (adjusted OR 0.83; 95% CI 0.67, 1.04) for evening vs. daily dosing over a mean of 19 months follow-up.ConclusionsAmong incident statin users from a real-world clinical setting, those with daily and evening dosing instructions had similar adherence rates and mean changes in LDL-c. Given potential clinical equipoise for evening and daily dosing, clinicians should consider patient-tailored statin dosing instructions to reduce potentially unnecessary regimen complexity.

Dataset Information

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

Background

Objective

Methods

Results

Conclusion

Publications

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

Similar Datasets

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