Differences in statin utilization and lipid lowering by race, ethnicity, and HIV status in a real-world cohort of persons with human immunodeficiency virus and uninfected persons.
Differences in statin utilization and lipid lowering by race, ethnicity, and HIV status in a real-world cohort of persons with human immunodeficiency virus and uninfected persons.
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DOI：
10.1016/j.ahj.2018.11.012
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发表时间：
2019-03
影响因子：
4.8
通讯作者：
中科院分区：
文献类型：
--
作者：
在感染艾滋病毒(PWH)的人中，包括心肌梗死和中风在内的心血管疾病的风险增加。然而，在PWH中还没有完成他汀类药物使用与临床心血管疾病(CVD)终点的试验，而且关于他汀类药物使用和降脂有效性的真实数据也很少。因此，我们使用一个独特的威尔斯亲王和未感染对照队列来评估(1)威尔斯亲王使用的他汀类药物类型与未感染人群的差异；(2)威尔斯亲王使用他汀类药物对未感染人群的降脂效果；以及(3)威尔斯亲王医院和未感染人群在适当使用他汀类药物方面的种族和民族差异。我们分析了2000年1月1日至2017年5月17日期间在一家大型城市医疗中心接受护理的5,039名PWH和10,011名未感染的人口统计学匹配的对照组。用药记录、处方数据和经过验证的自然语言处理算法来确定他汀类药物的利用。他汀类药物按通用活性成分名称和强度(高、中、低)进行分类。在常规临床护理中收集的血脂值可用于分析。第一组分析仅限于服用他汀类药物的PWH和未感染的匹配对照组，并比较(1)他汀类药物类型的差异和(2)他汀类药物启动后与他汀类药物启动前的胆固醇水平的差异。对于第二组分析，我们首先使用流行的心血管危险因素来确定有他汀类药物适应症的参与者，然后确定这些参与者中有多少人在服用他汀类药物。然后，我们通过多变量调整的Logistic回归，比较了有他汀类药物适应症的人群(按种族/民族分组)和未感染的匹配对照组中他汀类药物的利用情况。在服用他汀类药物的患者中，PWH患者比对照组更有可能服用普伐他汀(34.8%比12.3%，P<；.001)或阿托伐他汀(72.2%比65.6%，P=.002)，而不太可能服用辛伐他汀(14.2%比39.5%，P<；.001)。在有他汀类药物使用指征的PWH中，55.7%的白人、39.4%的黑人和45.8%的拉美裔人服用了他汀类药物(P<；.001)。在对人口统计学因素(包括保险状况)、心血管危险因素、抗逆转录病毒治疗的使用、艾滋病毒病毒血症和CD4计数进行调整后，按种族/民族划分的他汀类药物处方的差异仍然显著。在未感染的人群中，他汀类药物利用方面的种族/民族差异不那么明显。在有他汀类药物适应症的PWH中(S)，黑人和西班牙裔比白人更不可能服用他汀类药物。这些种族/族裔差异在未感染的人中不那么明显。与未感染的匹配对照组相比，用于PWH的他汀类药物的类型有显著差异。今后有必要努力解决威斯康星医院在预防心血管疾病方面的差异。
Risks for cardiovascular diseases, including myocardial infarction and stroke, are elevated in people with HIV infection (PWH). However, no trials of statin utilization with clinical cardiovascular disease (CVD) end points have been completed in PWH, and there are sparse real-world data regarding statin use and lipid-lowering effectiveness. We therefore used a unique cohort of PWH and uninfected controls to evaluate (1) differences in statin types used for PWH versus uninfected persons; (2) lipid lowering achieved by statin use for PWH versus uninfected persons; and (3) racial and ethnic disparities in appropriate statin use among PWH and uninfected persons. We analyzed a cohort of 5,039 PWH and 10,011 uninfected demographically matched controls who received care at a large urban medical center between January 1, 2000, and May 17, 2017. Medication administration records, prescription data, and validated natural language processing algorithms were used to determine statin utilization. Statins were categorized by generic active ingredient name and intensity (high, moderate, or low). Lipid values collected in routine clinical care were available for analysis. The first set of analyses was restricted to PWH and uninfected matched controls taking statins and compared (1) differences in statin type and (2) difference in cholesterol levels after versus before statin initiation by HIV status. For the second set of analyses, we first used prevalent CVD risk factors to determine participants with statin indications and then determined how many of these participants were taking statins. We then compared statin utilization among persons with indications for statins by race/ethnic group for PWH and uninfected matched controls using multivariable-adjusted logistic regression. Among people prescribed statins, PWH were more likely than controls to have ever taken pravastatin (34.8% vs 12.3%, P < .001) or atorvastatin (72.2% vs 65.6%, P = .002) and less likely to have ever taken simvastatin (14.2% vs 39.5%, P < .001). Among PWH with indications for statin utilization, 55.7% of whites, 39.4% of blacks, and 45.8% of Hispanics were prescribed statins (P < .001). These differences in statin prescription by race/ethnicity remained significant after adjustment for demographics (including insurance status), cardiovascular risk factors, antiretroviral therapy use, HIV viremia, and CD4 count. These racial/ethnic disparities in statin utilization were less pronounced among uninfected persons. Among PWH with statin indication(s), blacks and Hispanics were less likely than whites to have been prescribed a statin. These racial/ethnic disparities were less pronounced among uninfected persons. There were significant differences in type of statin used for PWH compared to uninfected matched controls. Future efforts addressing disparities in CVD prevention among PWH are warranted.
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影响因子：
168.9
作者：
Mihaylova, B.;Emberson, J.;Blackwell, L.;Keech, A.;Simes, J.;Barnes, E. H.;Voysey, M.;Gray, A.;Collins, R.;Baigent, C.;de Lemos, J.;Braunwald, E.;Blazing, M.;Murphy, S.;Downs, J. R.;Gotto, A.;Clearfield, M.;Holdaas, H.;Gordon, D.;Davis, B.;Koren, M.;Dahlof, B.;Poulter, N.;Sever, P.;Knopp, R. H.;Fellstrom, B.;Holdaas, H.;Jardine, A.;Schmieder, R.;Zannad, F.;Goldbourt, U.;Kaplinsky, E.;Colhoun, H. M.;Betteridge, D. J.;Durrington, P. N.;Hitman, G. A.;Fuller, J.;Neil, A.;Wanner, C.;Krane, V.;Sacks, F.;Moye, L.;Pfeffer, M.;Hawkins, C. M.;Braunwald, E.;Kjekshus, J.;Wedel, H.;Wikstrand, J.;Barter, P.;Keech, A.;Tavazzi, L.;Maggioni, A.;Marchioli, R.;Tognoni, G.;Franzosi, M. G.;Maggioni, A.;Bloomfield, H.;Robins, S.;Collins, R.;Armitage, J.;Keech, A.;Parish, S.;Peto, R.;Sleight, P.;Pedersen, T. R.;Ridker, P. M.;Holman, R.;Meade, T.;Simes, J.;Keech, A.;MacMahon, S.;Marschner, I.;Tonkin, A.;Shaw, J.;Serruys, P. W.;Nakamura, H.;Knatterud, G.;Furberg, C.;Byington, R.;Macfarlane, P.;Cobbe, S.;Ford, I.;Murphy, M.;Blauw, G. J.;Packard, C.;Shepherd, J.;Kjekshus, J.;Pedersen, T.;Wilhelmsen, L.;Braunwald, E.;Cannon, C.;Murphy, S.;Collins, R.;Armitage, J.;Bowman, L.;Parish, S.;Peto, R.;Sleight, P.;Baigent, C.;Landray, M.;Collins, R.;La Rosa, J.;Rossouw, J.;Probstfield, J.;Shepherd, J.;Cobbe, S.;Macfarlane, P.;Ford, I.
通讯作者：
Ford, I.
影响因子：
33.9
作者：
Dasgupta, Sharoda;Oster, Alexandra M.;Hall, H. Irene
通讯作者：
Hall, H. Irene
DOI：
10.1080/09540121.2014.911813
发表时间：
2014-01-01
影响因子：
1.7
作者：
Felsen, Uriel R.;Bellin, Eran Y.;Zingman, Barry S.
通讯作者：
Zingman, Barry S.
影响因子：
8.3
作者：
Steverson AB;Pawlowski AE;Schneider D;Nannapaneni P;Sanders JM;Achenbach CJ;Shah SJ;Lloyd-Jones DM;Feinstein MJ
通讯作者：
Feinstein MJ
影响因子：
5.4
作者：
Schroff, Praful;Gamboa, Christopher M.;Safford, Monika M.
通讯作者：
Safford, Monika M.