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
| Autor: | A. Di Biagio, Vincenzo Spagnuolo, M. D’Abbraccio, Laura Sighinolfi, Gabriella d'Ettorre, Nicola Squillace, Paolo Maggi, Stefano Rusconi, G. V. De Socio, Giuseppe Nunnari, Stefania Cicalini, Canio Martinelli |
|---|---|
| Přispěvatelé: | 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., 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 |
| Jazyk: | angličtina |
| Rok vydání: | 2019 |
| Předmět: |
lcsh:Immunologic diseases. Allergy
0301 basic medicine Drug Adult medicine.medical_specialty Statin medicine.drug_class media_common.quotation_subject Atorvastatin 030106 microbiology Population HIV Infections Disease 03 medical and health sciences 0302 clinical medicine Risk Factors Virology medicine Humans Pharmacology (medical) Rosuvastatin 030212 general & internal medicine Intensive care medicine education media_common Aged education.field_of_study Aspirin business.industry Methodology Antiplatelet agents Statins HIV Middle Aged Cardiovascular disease Oral anticoagulants United States Primary Prevention Cardiovascular Diseases Hydroxymethylglutaryl-CoA Reductase Inhibitors Practice Guidelines as Topic Molecular Medicine Position paper lcsh:RC581-607 business medicine.drug |
| Zdroj: | AIDS Research and Therapy AIDS Research and Therapy, Vol 16, Iss 1, Pp 1-8 (2019) |
| Popis: | 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. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|