Dyslipidemia and Hypertension Control in HIV-Positive Patients

HIV-infected patients have a 2-fold increased risk for MI vs HIV-negative patients. While many are treated for common risk factors, many of those do not reach clinical targets.

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.