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Association of Cardiologist Clinic Visits with Cardiovascular Primary Prevention Outcomes Among People with HIV from Underrepresented Racial and Ethnic Groups in the Southern United States.

Publication ,  Journal Article
Durstenfeld, MS; Hill, CL; Clare, RM; Chiswell, K; Sanders, G; Gray, S; Cooper, L; Vicini, J; Marsolo, K; Okeke, NL; Meissner, EG; Thomas, KL ...
Published in: medRxiv
August 9, 2024

BACKGROUND: People with HIV (PWH) are at elevated risk for atherosclerotic cardiovascular disease (ASCVD). Underrepresented racial and ethnic groups (UREGs) with HIV in the southern U.S. are disproportionately affected, yet whether cardiology specialist care for this at-risk group improves blood pressure and lipid control or prevents cardiovascular events is unknown. METHODS: We evaluated a cohort of PWH from UREGs at elevated ASCVD risk without known cardiovascular disease who received HIV-related care from 2015-2018 at four academic medical centers in the Southern United States with follow up through 2020. Primary outcomes were blood pressure control (<140/90 mmHg) and lipid control (LDL-C ≤ 100 mg/dl) over 2 years and time to first major adverse cardiovascular (MACE) event. Statistical analyses were adjusted for cohort/site and patient factors including HIV measures and comorbidities. RESULTS: Among 3972 included PWH (median age 47 years old, 32.6% female) without diagnosed cardiovascular disease, 276 (6.9%) had a cardiology clinic visit. Cardiology clinic visits were not significantly associated with subsequent blood pressure control (adjusted OR 0.78, 95% CI 0.49-1.24, p=0.29) or lipid control (adjusted OR 2.25, 95% CI 0.72-7.01, p=0.16). Over a median follow up of 5 years, patients who had a cardiology clinic visit had higher risk of MACE, overall mortality, and falsification endpoints (hospitalization or death from accident/trauma and pneumonia/sepsis) indicating a higher risk group overall, even after adjusting for measured risk factors. CONCLUSIONS: Among UREG PWH at elevated cardiovascular risk, a cardiology clinic visit was not associated with improved cardiovascular risk factors or reduced risk of cardiovascular events. Our study suggests that seeing a cardiologist is not alone sufficient to promote cardiovascular health or prevent cardiovascular events among PWH, but with low confidence given the higher risk among those who had a cardiology visit.

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medRxiv

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Publication Date

August 9, 2024

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United States
 

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Durstenfeld, M. S., Hill, C. L., Clare, R. M., Chiswell, K., Sanders, G., Gray, S., … Longenecker, C. T. (2024). Association of Cardiologist Clinic Visits with Cardiovascular Primary Prevention Outcomes Among People with HIV from Underrepresented Racial and Ethnic Groups in the Southern United States. MedRxiv. https://doi.org/10.1101/2024.08.08.24311709
Durstenfeld, Matthew S., C Larry Hill, Robert M. Clare, Karen Chiswell, Gretchen Sanders, Shamea Gray, Linda Cooper, et al. “Association of Cardiologist Clinic Visits with Cardiovascular Primary Prevention Outcomes Among People with HIV from Underrepresented Racial and Ethnic Groups in the Southern United States.MedRxiv, August 9, 2024. https://doi.org/10.1101/2024.08.08.24311709.
Durstenfeld MS, Hill CL, Clare RM, Chiswell K, Sanders G, Gray S, Cooper L, Vicini J, Marsolo K, Okeke NL, Meissner EG, Thomas KL, Morse CG, Bloomfield GS, Pettit AC, Longenecker CT. Association of Cardiologist Clinic Visits with Cardiovascular Primary Prevention Outcomes Among People with HIV from Underrepresented Racial and Ethnic Groups in the Southern United States. medRxiv. 2024 Aug 9;

Published In

medRxiv

DOI

Publication Date

August 9, 2024

Location

United States