Less than a fifth of people with HIV who qualify for aspirin therapy, for the prevention of cardiovascular disease, are receiving such treatment, US investigators report in the online edition of Clinical Infectious Diseases.
“Our study found that aspirin was markedly under prescribed among HIV-infected persons at risk for CVD [cardiovascular disease] events,” comment the authors. “HIV specific guidelines regarding use of aspirin are needed.”
Cardiovascular disease is now an important cause of illness and death in people with HIV. The causes are controversial, but seem to include traditional risk factors, the inflammatory effects of HIV and the side-effects of some antiretroviral drugs.
Low dose aspirin is widely used in the general population for the prevention of cardiovascular disease in people thought to be at risk. Aspirin reduces the clotting action of platelets, possibly reducing the risk of heart attack. The drug is also an anti-inflammatory.
In 2009, guidelines were issued in the US (see www.uspreventiveservicestaskforce.org/uspstf/uspsasmi.htm) recommending the use of aspirin for the prevention of cardiovascular events in men aged 45 to 79 years and women aged 55 to 79 years, when the potential benefits outweigh the risks of gastrointestinal bleeding, a recognised side-effect of aspirin.
Doctors in Alabama wanted to see how many people with HIV qualifying for aspirin therapy under these guidelines were receiving such treatment.
They designed a cross-sectional study involving people who received outpatient care between 2009 and 2010.
Men aged between 45 and 79 and women aged between 55 and 79 were eligible for inclusion. People who had experienced a cardiovascular event were excluded, as were those with potential contraindications for the use of aspirin. The study participants’ ten-year cardiovascular risk was calculated using the Framingham Risk Score.
A total of 397 people were included in the study. Their mean age was 52 years, 36% were African American and 94% were men. Most (96%) were taking antiretroviral therapy, 60% had an undetectable viral load and 70% had a CD4 cell count above 350 cells/mm3.
Only 66 people (17%) were prescribed aspirin for the prevention of cardiovascular disease. This was despite half having an intermediate to high ten-year risk (10% or above) of cardiovascular disease: 39% were smokers; 16% had diabetes; 63% had high cholesterol; 20% were obese; and 62% had high blood pressure.
Only 22% of these high-risk patients were taking aspirin therapy.
Factors associated with prescription of aspirin included diabetes (PR = 2.60; 95% CI, 1.28-5.27), high cholesterol (OR = 3.42; 95% CI, 1.55-7.56) and smoking (OR = 1.87; 95% CI, 1.03-3.41).
Patients were also more likely to be prescribed aspirin if they had multiple risk factors for cardiovascular disease (OR for each additional risk-factor = 2.13; 95% CI, 1.51-2.99).
The investigators describe this finding as “interesting” and believe it suggests “aspirin prescribing patterns may be influenced more by co-occurrence of these diagnoses rather than by…guidelines, given that all 397 patients qualified for aspirin based on these guidelines yet < 20% were receiving it.”
They believe their results point to a need to educative HIV physicians about the use of aspirin for the prevention of cardiovascular disease.
Burkholder GA et al. Underutilization of aspirin for primary prevention of cardiovascular disease among HIV-infected persons. Clin Infect Dis: online edition, 2012.