Statin Use and Efficacy Among HIV-Infected Patients by Cholesterol Risk Category

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DESCRIPTION (provided by applicant): HIV-infected patients are thought to be an at-risk group for elevated rates of cardiovascular disease (CVD), yet it is not known whether traditional cardiovascular preventative guidelines are applicable to this group. Specifically, it has not been determined whether treatment with statins reduces risk of acute myocardial infarction (AMI) for HIV-infected patients and whether criteria for statin use should be determined based on the National Cholesterol Education Program Adult Treatment Panel III (NCEP ATPIII) guidelines for management of dyslipidemia, which were developed for use in general populations. Data indicate that the mechanism of CVD in HIV populations may differ from the general population and may be driven in large part by HIV-associated inflammatory and immunologic changes, suggesting that strategies for cardiovascular prevention may differ as well. In the proposed study, we will assess the applicability of the NCEP ATPIII guidelines to HIV populations. Aim 1 will involve ascertaining whether statins are prescribed according to criteria for use, determining rates of statin use in HIV and matched control patients according to whether patients had attained their LDL goal prior to statin initiation. In Aim 2, we will investigate the association o statin therapy with incident AMI among HIV-infected patients, answering the question of whether AMI risk reduction with statins differs based on whether patients had met criteria for statin use prior to drug initiation. The finding we anticipate - that statins reduce cardiovascular risk even n HIV-infected patients who do not meet conventional criteria for use - would indicate that HIV-infected patients merit different and tailored criteria for statin use. The research design will harness the power of a large health care system-based data registry with infrastructure already tailored to assess specific CVD-related and HIV-related variables in HIV and matched control patients, thereby offering an innovative and efficient approach to answer the research questions. Advanced analytic techniques, including natural language processing tools and propensity score analysis, will be employed to enable the most rigorous observational data study. Moreover, the anticipated update of the NCEP guidelines provides a potential opportunity to assess our study hypotheses using the most up-to date recommendations for the general population. The proposed study will leverage existing data to advance the field of cardiovascular epidemiology and prevention in an at-risk subgroup, answering the following key and previously unanswered question: Should HIV providers prescribe statins to patients using the same criteria as for the general population? As the first study assessing cardiovascular risk reduction with statins among HIV-infected patients, the data will fill a critical knowledge gap, providing knowledge on the applicability of standard cardiovascular preventative guidelines for HIV populations and impacting the development of HIV-specific criteria for statin use through clinical trials. The findings will have broad relevance to both HIV clinical care paradigms and to cardiovascular risk reduction for at-risk populations with novel risk factors for CVD.