Abstract P125: Association of Cardiology Encounters for Underrepresented Racial and Ethnic Groups With Human Immunodeficiency Virus With Subsequent Lipid and Blood Pressure Control

People with HIV (PWH) are at elevated atherosclerotic cardiovascular disease (ASCVD) risk. 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 is unknown. We evaluated a cohort of UREGs with HIV at elevated ASCVD risk without known cardiovascular disease. Participants received HIV-related care from 2015-2018 at four academic medical centers in the Southern United States with follow up through 2020. To create the cardiology and non-cardiology comparator groups, we divided the study into 6-month intervals, creating 8 cohorts and identified eligible patients with a new cardiology encounter during the interval. We included those without a cardiology encounter in that interval or any prior as controls. Primary outcomes were blood pressure control (<140/90 mmHg) and lipid control (LDL-C ≤ 100 mg/dl) assessed during 2 years of follow-up. Statistical analyses were adjusted for cohort, patient factors, HIV measures, and comorbidities, and used random effects to account for repeated use of patients across cohorts. Among 4096 included individuals, 411 (10%) had a cardiology encounter (Table 1). Cardiology encounters were associated with subsequent lipid control (OR 2.55, 95% CI 1.17-5.55, p=0.02), but not blood pressure control (OR 0.94, 95% CI 0.46-1.92, p=0.86). Compared to those without a cardiology encounter, those with a cardiology encounter did not subsequently have lower LDL-C (0.46 mg/dl higher per month, p=0.03) or systolic blood pressure (0.05 mm Hg higher per month, p=0.07). Cardiology encounters are associated with lipid control for UREGs with HIV. The lack of a decrease in LDL or systolic blood pressure suggests cardiology encounters may not be adequate to improve blood pressure and lipid control, two major modifiable risk factors for atherosclerotic cardiovascular disease among PWH.

Duke Scholars

Author Gerald Bloomfield Medicine, Cardiology

Author Karen Chiswell