Provider Compliance With Guidelines for Management of Cardiovascular Risk in HIV-Infected Patients

Kenneth A. Lichtenstein, MD; Carl Armon, PhD; Kate Buchacz, PhD; Joan S. Chmiel, PhD; Kern Buckner, MD; Ellen Tedaldi, MD; Kathleen Wood, BSN; Scott D. Holmberg, MD; John T. Brooks, PhD; the HOPS Investigators

Suggested citation for this article: Lichtenstein KA, Armon C, Buchacz K, Chmiel JS, Buckner K, Tedaldi E, et al. Provider Compliance With Guidelines for Management of Cardiovascular Risk in HIV-Infected Patients. Prev Chronic Dis 2013;10:120083. DOI: http://dx.doi.org/10.5888/pcd10.120083

MEDSCAPE CME

Medscape, LLC is pleased to provide online continuing medical education (CME) for this journal article, allowing clinicians the opportunity to earn CME credit.
This activity has been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education through the joint sponsorship of Medscape, LLC and Preventing Chronic Disease. Medscape, LLC is accredited by the ACCME to provide continuing medical education for physicians.
Medscape, LLC designates this Journal-based CME activity for a maximum of 1 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
All other clinicians completing this activity will be issued a certificate of participation. To participate in this journal CME activity: (1) review the learning objectives and author disclosures; (2) study the education content; (3) take the post-test with a 70% minimum passing score and complete the evaluation at www.medscape.org/journal/pcd

; (4) view/print certificate.
Release date: January 23, 2013; Expiration date: January 23, 2014

Learning Objectives

Upon completion of this activity, participants will be able to:

Assess the association between HIV infection and cardiovascular risk factors
Analyze the cardiovascular risk profile of patients with HIV in the current study
Evaluate physician adherence to cardiovascular risk treatment among patients with HIV
Distinguish variables associated with not receiving recommended treatment for cardiovascular risk factors

EDITORS
Camille Martin, editor; Ellen Taratus, editor, Preventing Chronic Disease. Disclosure: Camille Martin and Ellen Taratus have disclosed no relevant financial relationships.
CME AUTHOR
Charles Vega, MD, Associate Professor and Residency Director, Department of Family Medicine, University of California-Irvine, Irvine. Disclosure: Charles P. Vega, MD, FAAFP, has disclosed no relevant financial relationships.
AUTHORS AND CREDENTIALS
Disclosures: Kenneth A. Lichtenstein, MD, has disclosed the following financial relationships: Received grants for clinical research from ViiV and Abbott. He serves on advisory boards for Bristol-Myers Squibb and ViiV; Carl Armon, PhD; Kate Buchacz, PhD; Joan S. Chmiel, PhD, have disclosed no relevant financial relationships; Kern Buckner, MD, has disclosed the following financial relationships: Serves on an advisory board for Genesee BioMedical and has intellectual property with that company. He serves on the Board of Directors and has intellectual property with Wireless Medical, Inc. He also is on the Speaker Bureau for Boehringer Ingelheim Pharmaceuticals, Inc.; Ellen Tedaldi, MD, receives research support from Merck; Kathleen Wood, BSN; Scott D. Holmberg, MD; John T. Brooks, PhD, have disclosed no relevant financial relationships.

Affiliations: Kenneth A. Lichtenstein, Kern Buckner, National Jewish Health, Denver, CO; Carl Armon, Kathleen Wood, Cerner Corporation, Vienna, VA; Kate Buchacz, Scott D. Holmberg, John T. Brooks, Centers for Disease Control and Prevention, Atlanta, GA; Joan S. Chmiel, Northwestern University, Feinberg School of Medicine, Chicago, IL; Ellen Tedaldi, Temple University School of Medicine, Philadelphia, PA.

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Abstract

Introduction
Compliance with National Cholesterol Education Program Adult Treatment Panel III (NCEP) guidelines has been shown to significantly reduce incident cardiovascular events. We investigated physicians’ compliance with NCEP guidelines to reduce cardiovascular disease (CVD) risk in a population infected with HIV.
Methods
We analyzed HIV Outpatient Study (HOPS) data, following eligible patients from January 1, 2002, or first HOPS visit thereafter to calculate 10-year cardiovascular risk (10yCVR), until September 30, 2009, death, or last office visit. We categorized participants into four 10yCVR strata, according to guidelines determined by NCEP, the Infectious Disease Society of America, and the Adult AIDS Clinical Trials Group. We calculated percentages of patients treated for dyslipidemia and hypertension, calculated percentages of patients who achieved recommended goals, and categorized them by 10yCVR stratum.
Results
Of 2,005 patients analyzed, 33.7% had fewer than 2 CVD risk factors. For patients who had 2 or more risk factors, 10yCVR was less than 10% for 28.2%, 10% to 20% for 18.2%, and higher than 20% for 20.0% of patients. Of patients eligible for treatment, 81% to 87% were treated for elevated low-density lipoprotein cholesterol/non–high-density lipoprotein cholesterol (LDL-C/non–HDL-C), 2% to 11% were treated for low HDL-C, 56% to 91% were treated for high triglycerides, and 46% to 69% were treated for hypertension. Patients in higher 10yCVR categories were less likely to meet treatment goals than patients in lower 10yCVR categories.
Conclusion
At least one-fifth of contemporary HOPS patients have a 10yCVR higher than 20%, yet a large percentage of at-risk patients who were eligible for pharmacologic treatment did not receive recommended interventions and did not reach recommended treatment goals. Opportunities exist for CVD prevention in the HIV-infected population.