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Am Heart J. 2017 Jan;183:91-101. doi: 10.1016/j.ahj.2016.10.013. Epub 2016 Oct 21.

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

Author information

1
AP-HP, Hôpitaux de l'Est Parisien, Hôpital Saint-Antoine, Service de Cardiologie, Paris, France; Sorbonne Universities, UPMC University Paris 06, Faculty of Medicine; INSERM, UMR_S 938, UPMC, Paris, France. Electronic address: franck.boccara@sat.aphp.fr.
2
INSERM, UMR_S 1136, Pierre Louis Institute of Epidemiology and Public Health, Paris, France; Sorbonne Universities, UPMC University Paris 6, UMR_S 1136, Pierre Louis Institute of Epidemiology and Public Health, Paris, France. Electronic address: joe.miantezila-basilua@aphp.fr.
3
INSERM, UMR_S 1136, Pierre Louis Institute of Epidemiology and Public Health, Paris, France; Sorbonne Universities, UPMC University Paris 6, UMR_S 1136, Pierre Louis Institute of Epidemiology and Public Health, Paris, France. Electronic address: mmary@ccde.chups.jussieu.fr.
4
AP-HP, Hôpitaux de l'Est Parisien, Hôpital Saint-Antoine, Service de Cardiologie, Paris, France; Sorbonne Universities, UPMC University Paris 06, Faculty of Medicine. Electronic address: sylvie.lang@sat.aphp.fr.
5
Cardiology Department Hôpital Henri-Mondor, Assistance-Publique-Hôpitaux de Paris & INSERM-U955, 51 Avenue du Maréchal de Lattre de Tassigny, Creteil, France. Electronic address: emmanuel.teiger@hmn.aphp.fr.
6
FACT (French Alliance for Cardiovascular clinical Trials), Département Hospitalo-Universitaire FIRE, AP-HP, Hôpital Bichat, Paris, France; Université Paris-Diderot, Sorbonne Paris Cité, Paris, France; INSERM U-1148, Paris, France; NHLI, Imperial College, Royal Brompton Hospital, London, UK. Electronic address: gabriel.steg@bch.aphp.fr.
7
Sorbonne Universities, UPMC University Paris 06, Faculty of Medicine, Department of Pharmacology and UMR ICAN 1166, Paris, France; AP-HP, Pitié-Salpêtrière Hospital, Department of Pharmacology and CIC-1421, Paris, France; INSERM, CIC-1421 and UMR ICAN 1166, Paris, France; Institute of Cardiometabolism and Nutrition (ICAN), Paris, France. Electronic address: christian.funck-brentano@psl.aphp.fr.
8
Department of Infectious and Tropical Diseases, Hôpital Saint-Antoine, AP-HP, and INSERM, UMR_S 1136, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Paris, France. Electronic address: pierre-marie.girard@aphp.fr.
9
INSERM, UMR_S 1136, Pierre Louis Institute of Epidemiology and Public Health, Paris, France; Sorbonne Universities, UPMC University Paris 6, UMR_S 1136, Pierre Louis Institute of Epidemiology and Public Health, Paris, France. Electronic address: dcostagliola@ccde.chups.jussieu.fr.
10
AP-HP, Hôpitaux de l'Est Parisien, Hôpital Saint-Antoine, Service de Cardiologie, Paris, France; Sorbonne Universities, UPMC University Paris 06, Faculty of Medicine. Electronic address: ariel.cohen@sat.aphp.fr.
11
INSERM, UMR_S 1136, Pierre Louis Institute of Epidemiology and Public Health, Paris, France; Sorbonne Universities, UPMC University Paris 6, UMR_S 1136, Pierre Louis Institute of Epidemiology and Public Health, Paris, France. Electronic address: mguiguet@ccde.chups.jussieu.fr.

Abstract

Knowledge about lipid interventions in secondary prevention in HIV-infected individuals is limited; studies are sparse.

METHODS:

A 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.

RESULTS:

Mean 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.

CONCLUSIONS:

In 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.

PMID:
27979047
DOI:
10.1016/j.ahj.2016.10.013
[Indexed for MEDLINE]

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