- Speaker presentation
- Open Access
Statin use in setting of HIV infection
- Kenneth Lichtenstein1
© Lichtenstein; licensee BioMed Central Ltd. 2014
- Published: 23 May 2014
- Statin Therapy
- Risk Calculation
- Incident Cardiovascular Event
- Incident Diabetes Mellitus
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 .
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 .
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.
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 .
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.
- Grundy SM, Cleeman JI, Merz CN, et al: National Heart, Lung, and Blood Institute; American College of Cardiology Foundation American Heart Association. Implications of recent clinical trials for the National Cholesterol Education Program Adult Treatment Panel III guidelines. Circulation. 2004, 110 (2): 227-239. 10.1161/01.CIR.0000133317.49796.0E.View ArticlePubMedGoogle Scholar
- Stone NJ, Robinson J, Lichtenstein AH, et al: Guideline on the treatment of blood cholesterol to reduce atherosclerotic cardiovascular risk in adults: A report of the American College of Cardiology/American Heart Association Task Force on practice guidelines. Circulation. 2013, Published on lineGoogle Scholar
- Law MG, Friis-Moller N, El-Sadr WM, et al: The use of Framingham equation to predict myocardial infarctions in HIV-infected patient: comparison with observed events in the D:A:D Study. HIV Med. 2006, 7: 218-230. 10.1111/j.1468-1293.2006.00362.x.View ArticlePubMedGoogle Scholar
- Triant VA, Lee H, Hadigan C, Grinspoon SK: Increased acute myocardial infarction rates and cardiovascular risk factors among patients with human immunodeficiency virus disease. J Clin Endocrinol Metab. 2007, 92: 2506-2512. 10.1210/jc.2006-2190.PubMed CentralView ArticlePubMedGoogle Scholar
- Hsue PY, Hunt PW, Schnell A, et al: Role of viral replication, antiretroviral therapy, and immunodeficiency in HIV-associated atherosclerosis. AIDS. 2009, 23: 1059-1067. 10.1097/QAD.0b013e32832b514b.PubMed CentralView ArticlePubMedGoogle Scholar
- Aslangul E, Assoumou , Bittar R, et al: Rosuvastatin versus pravastatin in dyslipidemic HIV-1-infected patients receiving protease inhibitors: a randomized trial. AIDS. 2010, 24: 77-83. 10.1097/QAD.0b013e328331d2ab.View ArticlePubMedGoogle Scholar
- Dube MP, Stein JH, Aberg JA, Fichtenbaum CJ, et al: Guidelines for the evaluation and management of dyslipidemia in human immunodeficiency virus (HIV)-infected adults receiving antiretroviral therapy: recommendations of the HIV Medical Association of the Infectious Disease Society of America and the Adult AIDS Clinical Trials Group. Clin Infect Dis. 2003, 37: 613-627. 10.1086/378131.View ArticlePubMedGoogle Scholar
- Sattar N, Preiss D, Murray HM, et al: Statins and risk of incident diabetes: a collaborative metaanalysis of randomized statin trials. Lancet. 2010, 375 (9716): 735-742. 10.1016/S0140-6736(09)61965-6.View ArticlePubMedGoogle Scholar
- Ridker PM, Danielson E, Fonseca F, et al: Cardiovascular benefits and diabetes risks of statin therapy in primary prevention: An analysis from the JUPITER Trial. N Engl J Med. 2008, 359: 2195-2207. 10.1056/NEJMoa0807646.View ArticlePubMedGoogle Scholar
- Sukhija R, Prayaga S, Maashdeh M, et al: Effect of statins on fasting plasma glucose in diabetic and nondiabetic patients. J Investig Med. 2009, 57: 495-499.PubMedGoogle Scholar
- Culver AL, Ockene IS, Balasubramanian R, et al: Statin use and risk of diabetes mellitus in postmenopausal women in the Women’s Health Initiative. Arch Intern Med. 2012Google Scholar
- Goldstein MR, Mascitelli L: Do statins cause diabetes mellitus?. Curr Diab Rep. 2013, 13 (3): 381-90. 10.1007/s11892-013-0368-x.View ArticlePubMedGoogle Scholar
- Carter AA, Gomes T, Camacho X, et al: Risk of incident diabetes among patients treated with statins: population based study. BMJ. 2013, 346: f2610-10.1136/bmj.f2610.PubMed CentralView ArticlePubMedGoogle Scholar
- Lichtenstein KA, Debes R, Wood K, Bozzette S, the HIV Outpatient Study investigators: 20th CROI. 2013, Abstract 767Google Scholar
This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.