Dyslipidemia and Hypertension Control in HIV-Positive Patients

Among patients infected with HIV, whose lifespan as a group has been considerably extended by antiretroviral therapy, cardiovascular disease is now a major cause of morbidity and mortality. HIV-infected patients have a 2-fold increased risk for myocardial infarction compared with HIV-negative patients.¹ Dyslipidemia and hypertension are both strong risk factors for the development of cardiovascular disease and control to target levels may help reduce the risk of atherosclerotic and other heart disease.

A new study published in the Journal of Acquired Immune Deficiency Syndromes (JAIDS)² was designed to better understand how the two risk factors are managed in an HIV treatment setting. The study examined the prevalence of low-density lipoprotein cholesterol (LDL-C) dyslipidemia and hypertension, the level of control of these risk factors, and factors potentially associated with their successful control in HIV-infected patients in an HIV/AIDS clinic that provides comprehensive care.  

The investigators reviewed the electronic medical records of 4278 HIV-infected patients aged 20 years or older in an urban HIV/AIDS clinic based in a large tertiary hospital and a designated New York State AIDS Center. The study defined LDL-C dyslipidemia according to the National Cholesterol Education Program Adult Treatment Panel III goals and hypertension according to Joint National Committee VII criteria. The prevalence of LDL-C dyslipidemia was 35%. Of these patients, 90% were treated and 75% of those treated were at their treatment goal. Patients in high-risk groups (56%), including those with known coronary artery disease (57%) or coronary heart disease equivalents (62%), were less likely to be at LDL-C treatment goal. Of the 43% who had hypertension, 75% were treated, with just over half (57%) at goal.²

This trial is unique because it includes patients recruited into a clinical trial, thus reflecting “real-world” conditions.² Despite knowledge that patients infected with HIV are at higher risk for cardiovascular disease compared with non–HIV-infected patients, current guidelines for LDL-C do not recommend more stringent goals for HIV patients. Primary care physicians should be aware of the increased risk of cardiovascular events in HIV-infected patients and aggressively pursue management of all relevant risk factors.

Disclosures:

• Grinspoon SK, Grunfeld C, Kotler DP, et al. State of the science conference: initiative to decrease cardiovascular risk and increase quality of care for patients living with HIV/AIDS: executive summary. Circulation. 2008;118:198–210.
• Myerson M1, Poltavskiy E, Armstrong EJ, Kim S, Sharp V, Bang H. Prevalence, treatment, and control of dyslipidemia and hypertension in 4278 HIV outpatients.J Acquir Immune Defic Syndr.2014;6:370-377.