Research Activities, May 2013
Not enough HIV patients are receiving aspirin for primary prevention of heart disease
Thanks to advances in HIV care and treatment, persons with HIV disease are living much longer. In fact, more than half of those with HIV will be more than 50 years of age by 2015. These individuals are at increased risk for cardiovascular disease (CVD) and related stroke and heart attack due to advancing age and other factors. As with non-HIV-infected individuals, those with HIV can benefit from taking aspirin to prevent heart attack or stroke. Yet, less than 1 in 5 patients with HIV disease who qualify for aspirin for primary CVD prevention are receiving it.
Patients who qualified for the study had two or more primary provider visits at a major academic medical center HIV clinic. A subset of patients meeting age criteria and with no prior history of CVD then underwent coronary heart disease risk assessment using Framingham Risk Score criteria. The 397 study patients had an average age of 52.2 years, the majority were male (94 percent), and 36 percent were black. Only 17 percent of patients had aspirin prescribed to them to prevent CVD, even though half of the patients studied had an intermediate to high risk for CVD. Among these individuals, 39 percent were smokers, 62 percent had high blood pressure, 63 percent had abnormal lipid profiles, and 16 percent had diabetes. One in 5 was considered obese. Even among the intermediate-to high-risk patients, only 22 percent were receiving aspirin. Diabetes, high lipid profiles, and smoking were significantly associated with the likelihood of receiving aspirin.
According to the researchers, guidelines are needed that specifically address the value of aspirin regimens for the prevention of CVD in patients with HIV infection. The study was supported in part by AHRQ (HS13852).
See "Underutilization of aspirin for primary prevention of cardiovascular disease among HIV-infected patients," by Greer A. Burkholder, M.D., Ashutosh R. Tamhane, M.D., Ph.D., Jorge L. Salinas, M.D., and others in the December 1, 2012, Clinical Infectious Diseases 55, pp. 1550-1557.