Statin therapy and low-density lipoprotein cholesterol reduction in HIV-infected individuals after acute coronary syndrome: Results from the PACS-HIV lipids substudy

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• 作者：Franck Boccara ; MD ; PhD^a ; ^b ; ^{franck.boccara@sat.aphp.fr} ; ^{franck.boccara@aphp.fr} ; Joe Miantezila Basilua ; MSc^c ; ^d ; ^{joe.miantezila-basilua@aphp.fr} ; Murielle Mary-Krause ; PhD^c ; ^d ; ^{mmary@ccde.chups.jussieu.fr} ; Sylvie Lang ; PhD^a ; ^{sylvie.lang@sat.aphp.fr} ; Emmanuel Teiger ; MD ; PhD^e ; ^{emmanuel.teiger@hmn.aphp.fr} ; Philippe Gabriel Steg ; MD^f ; ^g ; ^h ; ⁱ ; ^{gabriel.steg@bch.aphp.fr} ; Christian Funck-Brentano ; MD ; PhD^j ; ^k ; ^l ; ^m ; ^{christian.funck-brentano@psl.aphp.fr} ; Pierre-Marie Girard ; MD ; PhDⁿ ; ^{pierre-marie.girard@aphp.fr} ; Dominique Costagliola ; PhD^c ; ^d ; ^{dcostagliola@ccde.chups.jussieu.fr} ; Ariel Cohen ; MD ; PhD^a ; ^{ariel.cohen@sat.aphp.fr} ; Marguerite Guiguet ; PhD^c ; ^d ; ^{mguiguet@ccde.chups.jussieu.fr} ; on behalf the PACS-HIV investigators (Prognosis of Acute Coronary Syndrome in HIV-infected patients)
• 刊名：American Heart Journal
• 出版年：2017
• 出版时间：January 2017
• 年：2017
• 卷：183
• 期：Complete
• 页码：91-101
• 全文大小：571 K
• 卷排序：183

文摘

Knowledge about lipid interventions in secondary prevention in HIV-infected individuals is limited; studies are sparse.MethodsA prospective observational multicenter study enrolled 282 patients on statin 1 month after first acute coronary syndrome (ACS) (95 HIV-infected individuals, 187 HIV-uninfected). Data on fasting lipids (total cholesterol [TC], low-density lipoprotein cholesterol, high-density lipoprotein cholesterol [HDL-C], non–HDL-C, triglycerides, TC/HDL-C ratio) were collected over 3 years. The evolution of lipid concentrations was analyzed using mixed-effects models. Achievement of National Cholesterol Education Program Adult Treatment Panel III lipid goals and prescribed statin intensity was assessed.ResultsMean age of patients was 49.0 years, and 94% were men. Baseline lipids were similar in the 2 groups. Six months after first ACS, less low-density lipoprotein cholesterol reduction was observed in the HIV-infected GROUP (adjusted mean change −10.13; 95% CI −20.63 to 0.37; P = .06) than in the HIV-uninfected group (Adjusted mean change −38.51; 95% CI −46.00 to −31.04; P < .0001) Similar trends were observed for TC and non–HDL-C. After ACS, initial statin prescription for HIV-infected compared with HIV-uninfected individuals was more frequently a moderate-intensity statin (66% vs 45%) and less frequently a high-intensity statin (15% vs 45%). Over 3 years of follow-up, the proportion of HIV-infected patients receiving high-intensity statin remained persistently lower than the proportion observed in the HIV-uninfected group.ConclusionsIn this observational study, HIV-infected individuals after first ACS exhibited worse lipid profiles than controls particularly during the first 6 months while receiving less potent statins. Appropriate statin intensity should be prescribed in HIV-infected individuals with awareness of potential drug-drug interactions.