American doctors are less likely to prescribe key recommended medications for the prevention of cardiovascular disease to HIV-positive people compared to HIV-negative people, according to a new study based on representative national sources.
The researchers looked at the healthcare that was provided to people aged 40 to 79 who had already had heart disease and related problems, or had risk factors for these problems occurring. This would include people with raised cholesterol or high blood pressure, and people who had had heart failure, heart attacks or stroke.
The study included data from the medical appointments of 1631 people living with HIV and over 200,000 people who don’t have HIV.
Antiplatelet medicines reduce the risk of blood clots forming. Examples of antiplatelet medicines include aspirin (a different dose to that needed for a headache), clopidogrel, prasugrel and ticagrelor. Guidelines recommend these medicines for people who’ve had cardiovascular disease and for older adults at risk of it.
But the researchers found that only 5% of eligible people with HIV were prescribed antiplatelets, compared to 14% of eligible people who don’t have HIV.
Statins lower the amount of cholesterol in the blood, especially the harmful type known as LDL cholesterol. This helps prevent a build up of fatty deposits in the arteries, so reducing the risk of heart attacks and strokes. Statins include atorvastatin, pravastatin and simvastatin. Some statins interact with some anti-HIV drugs, so it is important that a doctor prescribing a statin knows if you are on HIV treatment.
In the study, rates of statin use among people with diabetes, cardiovascular disease or high lipids were markedly lower for people with HIV (23%) than people without HIV (35%).
Several types of medicine are used to treat high blood pressure. They include ACE inhibitors, angiotensin-II receptor antagonists, calcium-channel blockers and diuretics.
More encouragingly the study found that use of these drugs in people with high blood pressure was similar whether people had HIV (53%) or not (58%).
And doctors gave similar support to people to help them stop smoking, have a more active lifestyle or eat more healthily, regardless of HIV status.
But the researchers say that one of the reasons why rates of heart attacks, strokes and other forms of cardiovascular disease are high in people with HIV might be that they are not getting all the preventative drug treatments that they need.
Another study looked at the presence of 'silent' cerebral vascular disease: damage or blockage of small blood vessels in the brain, which can lead to strokes or neurocognitive problems such as memory loss and dementia. The study found that one in five people living with HIV had evidence of severe small-vessel disease, compared to one in seven people without HIV of a similar age.
The study found that silent cerebral vascular disease was strongly associated with older age, lower CD4 cell count prior to treatment and high blood pressure.
Small-vessel disease is more likely to lead to lead to a stroke than large-vessel disease in people with high blood pressure, the authors say, underlining the importance of detecting and treating high blood pressure in people with HIV.