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Low Aspirin Use for Primary Heart Disease Prevention in US HIV Group

Author: Mark Mascolini

04 December 2012

Fewer than 1 in 5 HIV-positive people in care at the University of Alabama and qualifying for primary cardiovascular disease prevention received a prescription for low-dose aspirin. Aspirin use was more likely in people with multiple cardiovascular risk factors.

HIV-positive people run an increased risk for cardiovascular disease. Daily low-dose aspirin is a well-known primary prevention strategy, but its use in HIV populations is largely unknown. To determine aspirin use and predictors of use, University of Alabama researchers conducted this cross-sectional study in 2010.

The investigators calculated 10-year risk of cardiovascular disease in men 45 to 79 years old and in women 55 to 79 years old. They used the 2009 US Preventive Services Task Force (USPSTF) guidelines to determine which patients qualified for primary cardiovascular disease prevention with aspirin.

Of the 397 patients who qualified for daily aspirin, 94% were men, 36% were African American, and age averaged 52.2 years. Only 66 of these 397 people (17%) were prescribed aspirin.

Regression analysis identified three factors that independently raised the odds of aspirin prescription, at the following odds ratios (OR) (and 95% confidence intervals):

• Diabetes mellitus: OR 2.60 (1.28 to 5.27)
• Hyperlipidemia: OR 3.42 (1.55 to 7.56)
• Current smoking: OR 1.87 (1.03 to 3.41)

Every additional cardiovascular risk factor among hypertension, diabetes, hyperlipidemia, and smoking more than doubled the odds of an aspirin prescription (OR 2.13, 95% confidence interval 1.51 to 2.99).

“Escalating likelihood of aspirin prescription with increasing cardiovascular disease-related comorbidity count suggests that providers may be influenced more by co-occurrence of these diagnoses than by USPSTF guidelines,” the authors propose.

“In the absence of HIV-specific guidelines,” they add, “interventions to improve HIV provider awareness of and adherence to existing general population guidelines on cardiovascular disease risk reduction are needed.”

Source: Greer A. Burkholder, Ashutosh R. Tamhane, Jorge L. Salinas, Michael J. Mugavero, James L. Raper, Andrew O. Westfall, Michael S. Saag, James H. Willig. Underutilization of aspirin for primary prevention of cardiovascular disease among HIV-infected patients. Clinical Infectious Diseases. 2012; 55: 1550-1557.

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