title: 2013 American College of Cardiology/American Heart Association and 2004 Adult Treatment Panel III cholesterol guidelines applied to HIV-infected patients with/without subclinical high-risk coronary plaque.
abstract: BACKGROUND
  The 2013 American College of Cardiology/American Heart Association (ACC/AHA) cholesterol guidelines are being applied to HIV-infected patients but have not been validated in this at-risk population, which is known to have a high prevalence of subclinical high-risk morphology (HRM) coronary atherosclerotic plaque.
  
  
  OBJECTIVE
  To compare recommendations for statins among HIV-infected subjects with/without HRM coronary plaque according to 2013 ACC/AHA versus 2004 Adult Treatment Panel III guidelines.
  
  
  METHODS
  Data from 108 HIV-infected subjects without known cardiovascular disease (CVD) or lipid-lowering treatment who underwent contrast-enhanced computed tomography angiography were analyzed. Recommendations for statin therapy according to 2013 versus 2004 guidelines were assessed among those with/without HRM coronary plaque.
  
  
  RESULTS
  Among all subjects, 10-year atherosclerotic cardiovascular disease (ASCVD) risk score was 3.3% (1.6, 6.6), yet 36% of subjects had HRM coronary plaque. Among those with HRM coronary plaque, statins would be recommended for 26% by 2013 guidelines versus 10% by 2004 guidelines (P = 0.04). Conversely, among those without HRM coronary plaque, statins would be recommended for 19% by 2013 guidelines versus 7% by 2004 guidelines (P = 0.005). In multivariate modeling, while 10-year ASCVD risk score related to HRM coronary plaque burden (P = 0.02), so too did other factors not incorporated into 2013 guidelines.
  
  
  CONCLUSIONS
  The 2013 ACC/AHA cholesterol guidelines recommend statin therapy for a higher percentage of subjects with and without HRM coronary plaque relative to 2004 guidelines. However, even by 2013 guidelines, statin therapy would not be recommended for the majority (74%) of HIV-infected subjects with subclinical HRM coronary plaque. Outcome studies are needed to determine the utility of new statin recommendations and the contribution of HRM coronary plaque to CVD events among HIV-infected subjects.
authors.affiliation: aProgram in Nutritional Metabolism bBiostatistics Center cDepartment of Radiology, Cardiovascular Imaging Section dDivision of Cardiology, Massachusetts General Hospital and Harvard Medical School eHarvard School of Public Health, Boston, Massachusetts fDivision of Cardiology, Duke University School of Medicine, Durham, North Carolina, USA.
authors.forename: Markella V
authors.initials: MV
authors.lastname: Zanni
authors.forename: Kathleen V
authors.initials: KV
authors.lastname: Fitch
authors.forename: Meghan
authors.initials: M
authors.lastname: Feldpausch
authors.forename: Allison
authors.initials: A
authors.lastname: Han
authors.forename: Hang
authors.initials: H
authors.lastname: Lee
authors.forename: Michael T
authors.initials: MT
authors.lastname: Lu
authors.forename: Suhny
authors.initials: S
authors.lastname: Abbara
authors.forename: Heather
authors.initials: H
authors.lastname: Ribaudo
authors.forename: Pamela S
authors.initials: PS
authors.lastname: Douglas
authors.forename: Udo
authors.initials: U
authors.lastname: Hoffmann
authors.forename: Janet
authors.initials: J
authors.lastname: Lo
authors.forename: Steven K
authors.initials: SK
authors.lastname: Grinspoon
mesh_terms: D000293:Adolescent; D000328:Adult; D000572:American Heart Association; D002784:Cholesterol / Q000097:blood*; D003287:Contrast Media; D017023:Coronary Angiography / Q000379:methods; D015658:HIV Infections / Q000097:blood* / Q000150:complications / Q000188:drug therapy / Q000473:pathology*; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use*; D008875:Middle Aged; D061330:Multidetector Computed Tomography / Q000379:methods; D058226:Plaque, Atherosclerotic / Q000097:blood / Q000150:complications* / Q000175:diagnosis*; D017410:Practice Guidelines as Topic; D012307:Risk Factors; D014481:United States / Q000453:epidemiology
chemical_list: D003287:Contrast Media; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D002784:Cholesterol