Incidence of statin initiation among people with and without HIV in the US: a prospective observational study

Background To reduce atherosclerotic cardiovascular disease (ASCVD) among US people living with HIV (PLWH), it is critical to assess shortfalls in statin initiation. We aimed to describe patterns in clinically-indicated statin initiation among demographically similar people with, or at increased vulnerability to, HIV. Methods Using data from the Multicenter AIDS Cohort Study and Women’s Interagency HIV Study, we followed 842 men and 852 women with an indication for statin use based on 2013 American College of Cardiology/American Heart Association guidelines for statin initiation between January 2014–March 2020. We estimated two-year incidence of statin initiation stratified by demographic, clinical, and behavioral characteristics and compared estimates using incidence differences. Results Within two years of clinical indication for statin therapy, 20% of participants reported statin use. Initiation of statin therapy did not differ significantly by HIV status. However, initiation was lower among Black versus non-Black persons, especially among men (14.0% versus 22.3%; Difference: -8.3%; 95% CI: -13.8%, -2.8%). Compared to initiation among persons indicated based only on ≥7.5% 10-year predicted ASCVD risk (Incidence, men: 14.2%; women: 15.2%), initiation was higher among those with existing ASCVD (Incidence, men: 32.9%; women: 22.0%) or diabetes (Incidence, men: 26.4%; women: 24.5%). Initiation was lower among current versus non-current smokers and higher among those with comorbidities such as obesity. Conclusions Guideline-driven statin initiation was low, with large inequities by race. With indications for statin use expanding for PLWH, redressing barriers to guideline implementation will be crucial to achieve improved outcomes through uptake of these evidence-based therapies.