Abstract
As HIV-infected individuals age due to improved antiretroviral therapy, they may be at increased risk for age-related co-morbidities such as cardiovascular disease (CVD). Increasing numbers of these individuals are initiating statins by meeting criteria for primary cardiovascular disease prevention [1]. Previous guidelines for the general population had recommended statin therapy based on 10-year cardiovascular risk (CV risk) with goal LDL-cholesterol (LDL-C) levels depending on the risk score. The latest guidelines have changed to identify four statin-requiring risk groups. They include: 1. Patients with known atherosclerotic cardiovascular disease. 2. Individuals with LDL-C ≥ 190 mg/dL (≥ 4.91 mmol/L). 3. Anyone age 40 to 75 with Type 1 or 2 diabetes mellitus (DM). 4. Individuals with a 10-year CV risk ≥ 7.5%. Statin therapy is then considered moderate intensity or high intensity when achieving a 30-50% reduction or > 50% reduction in LDL-C, respectively. The guidelines define the intensity of therapy that applies [2]. In HIV infection, incident cardiovascular events are higher than that of the general population [3-5]. Clinical judgment must be brought into play when deciding whether to follow the general population guidelines for calculation of 10-year CV risk and whether to select a lower risk value at which to start therapy. Also, there are three calculators: 1. Framingham risk calculation. 2. Pooled cohort risk calculation. 3. D*A*D risk calculation. To date, management guidelines in HIV-infection are lacking. Providers must also be cognizant of the interactions of statins with protease-inhibitors and other drugs metabolized by the cytochrome CYP 3A enzyme and adjust the doses accordingly [6,7]. Finally, statins have recently been found to be associated with incident (DM). In the general population the benefits of statin therapy outweigh the risks of incident DM [8-13]. A study in an HIV-infected population demonstrated similar incidence of DM as compared to studies in the general population [14]. Statin therapy reduces CVD events in all at risk patients. Initiation of statin therapy in HIV-infection requires additional clinical judgment due to the increase risk of CVD events and drug interactions. The cardiovascular disease benefits of statins outweigh the risks of incident DM.
Highlights
As HIV-infected individuals age due to improved antiretroviral therapy, they may be at increased risk for agerelated co-morbidities such as cardiovascular disease (CVD)
Previous guidelines for the general population had recommended statin therapy based on 10-year cardiovascular risk (CV risk) with goal LDL-cholesterol (LDL-C) levels depending on the risk score
Statin therapy is considered moderate intensity or high intensity when achieving a 30-50% reduction or > 50% reduction in LDL-C, respectively
Summary
As HIV-infected individuals age due to improved antiretroviral therapy, they may be at increased risk for agerelated co-morbidities such as cardiovascular disease (CVD). Previous guidelines for the general population had recommended statin therapy based on 10-year cardiovascular risk (CV risk) with goal LDL-cholesterol (LDL-C) levels depending on the risk score. The latest guidelines have changed to identify four statin-requiring risk groups. 2. Individuals with LDL-C ≥ 190 mg/dL (≥ 4.91 mmol/L).
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