Statins and aspirin in the prevention of cardiovascular disease among HIV-positive patients between controversies and unmet needs

Review of the literature and suggestions for a friendly use

P. Maggi, G. V. De Socio, S. Cicalini, M. D'Abbraccio, G. Dettorre, A. Di Biagio, C. Martinelli, G. Nunnari, S. Rusconi, L. Sighinolfi, V. Spagnuolo, N. Squillace

Research output: Contribution to journalArticle

Abstract

Background: As in non-infected subjects, statins and aspirin have a pivotal preventive role in reducing the cardiovascular related morbidity and mortality in HIV infected patients. The persistence of immune activation in these subjects, could contribute to accelerate atherosclerosis, therefore, these treatments that reduce inflammation could provide additional cardiovascular protection. However the current guidelines for the use of these drugs in general population are dissimilar, with important differences between American and European ones. Aim of the present position paper is to provide recommendations aimed to overcome the actual differences and limitations among the current ones and to adapt them to the needs of HIV infected patients. Results: We propose to adopt the new ACC/AHA guidelines, simple to use and cost effective, to use the ASCVD score that seems to estimate more accurately the cardiovascular risk among these patients. We suggest to start statin therapy in all patients with a calculated 10-year risk of a cardiovascular event of 10% or greater. Rosuvastatin and atorvastatin should be preferred. LDL-C target may be adopted. Aspirin should be always associated with a statin, in secondary prevention, while in primary prevention it should be reserved only to patients with ≥ 20% 10-year risk particularly adherent to treatments, and with low risk of bleeding. We suggest to start with a dose of 100 mg/day. Finally, management of antiplatelet agents or novel oral anticoagulants may include selecting antiretrovirals with a lower potential for drug interactions or choosing agents least likely to interact with antiretrovirals. Conclusions: As demonstrated in surveys, HIV physicians are generally highly committed regarding CVD and autonomous in prescribing statins and ASA. Consequently, in the light of the previously discussed discrepancies among the different guidelines and of the incomplete indications regarding HIV-positive persons, the present suggestions could overcome the actual differences and limitations among the current ones.

Original languageEnglish
Article number11
Pages (from-to)1-8
Number of pages8
JournalAIDS Research and Therapy
Volume16
Issue number1
DOIs
Publication statusPublished - May 24 2019

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Hydroxymethylglutaryl-CoA Reductase Inhibitors
Aspirin
Cardiovascular Diseases
HIV
Guidelines
Platelet Aggregation Inhibitors
Primary Prevention
Secondary Prevention
Drug Interactions
Anticoagulants
Atherosclerosis
Therapeutics
Hemorrhage
Inflammation
Morbidity
Physicians
Costs and Cost Analysis
Mortality
Pharmaceutical Preparations
Population

Keywords

  • Antiplatelet agents
  • Aspirin
  • Cardiovascular disease
  • HIV
  • Oral anticoagulants
  • Statins

ASJC Scopus subject areas

  • Molecular Medicine
  • Virology
  • Pharmacology (medical)

Cite this

Statins and aspirin in the prevention of cardiovascular disease among HIV-positive patients between controversies and unmet needs : Review of the literature and suggestions for a friendly use. / Maggi, P.; De Socio, G. V.; Cicalini, S.; D'Abbraccio, M.; Dettorre, G.; Di Biagio, A.; Martinelli, C.; Nunnari, G.; Rusconi, S.; Sighinolfi, L.; Spagnuolo, V.; Squillace, N.

In: AIDS Research and Therapy, Vol. 16, No. 1, 11, 24.05.2019, p. 1-8.

Research output: Contribution to journalArticle

Maggi, P, De Socio, GV, Cicalini, S, D'Abbraccio, M, Dettorre, G, Di Biagio, A, Martinelli, C, Nunnari, G, Rusconi, S, Sighinolfi, L, Spagnuolo, V & Squillace, N 2019, 'Statins and aspirin in the prevention of cardiovascular disease among HIV-positive patients between controversies and unmet needs: Review of the literature and suggestions for a friendly use', AIDS Research and Therapy, vol. 16, no. 1, 11, pp. 1-8. https://doi.org/10.1186/s12981-019-0226-2
Maggi, P. ; De Socio, G. V. ; Cicalini, S. ; D'Abbraccio, M. ; Dettorre, G. ; Di Biagio, A. ; Martinelli, C. ; Nunnari, G. ; Rusconi, S. ; Sighinolfi, L. ; Spagnuolo, V. ; Squillace, N. / Statins and aspirin in the prevention of cardiovascular disease among HIV-positive patients between controversies and unmet needs : Review of the literature and suggestions for a friendly use. In: AIDS Research and Therapy. 2019 ; Vol. 16, No. 1. pp. 1-8.
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abstract = "Background: As in non-infected subjects, statins and aspirin have a pivotal preventive role in reducing the cardiovascular related morbidity and mortality in HIV infected patients. The persistence of immune activation in these subjects, could contribute to accelerate atherosclerosis, therefore, these treatments that reduce inflammation could provide additional cardiovascular protection. However the current guidelines for the use of these drugs in general population are dissimilar, with important differences between American and European ones. Aim of the present position paper is to provide recommendations aimed to overcome the actual differences and limitations among the current ones and to adapt them to the needs of HIV infected patients. Results: We propose to adopt the new ACC/AHA guidelines, simple to use and cost effective, to use the ASCVD score that seems to estimate more accurately the cardiovascular risk among these patients. We suggest to start statin therapy in all patients with a calculated 10-year risk of a cardiovascular event of 10{\%} or greater. Rosuvastatin and atorvastatin should be preferred. LDL-C target may be adopted. Aspirin should be always associated with a statin, in secondary prevention, while in primary prevention it should be reserved only to patients with ≥ 20{\%} 10-year risk particularly adherent to treatments, and with low risk of bleeding. We suggest to start with a dose of 100 mg/day. Finally, management of antiplatelet agents or novel oral anticoagulants may include selecting antiretrovirals with a lower potential for drug interactions or choosing agents least likely to interact with antiretrovirals. Conclusions: As demonstrated in surveys, HIV physicians are generally highly committed regarding CVD and autonomous in prescribing statins and ASA. Consequently, in the light of the previously discussed discrepancies among the different guidelines and of the incomplete indications regarding HIV-positive persons, the present suggestions could overcome the actual differences and limitations among the current ones.",
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