Cardiovascular risk and achievement of target levels in low-density lipoprotein cholesterol in people living with HIV: insights from the DUALIS study

Abstract

Objectives: This post-hoc evaluation of the DUALIS study aimed to examine cardiovascular risk and the achievement of low-density lipoprotein cholesterol (LDL-C) targets in a virologically suppressed cohort of people living with HIV in Germany. Methods: Baseline cardiovascular risk was assessed using the European Society of Cardiology (ESC)-Systematic COronary Risk Evaluation 2 (SCORE2)/SCORE2-Older Persons (OP) and the current ESC guideline-recommended LDL-C targets among participants aged ≥40 years in the DUALIS study. Risk categorization was based on the ESC-SCORE2/SCORE2-OP results and the presence of specific comorbidities indicative of high risk and very high risk of CVD. Participants were enrolled between July 2015 and June 2017. Results: The use of lipid-lowering therapy (LLT) was low in the DUALIS study, with 12 out of 188 participants (6%) receiving the treatment. The median ESC-SCORE2/SCORE2-OP was 5.0%. Overall, 92 participants (49%) had low-to-moderate CVD risk, 77 (41%) high risk, and 19 (10%) very high risk. Only one participant in the high-risk group and none in the very high-risk group met the guideline-recommended LDL-C targets. Even when using the less stringent LDL-C targets valid at the time of data collection (2016 ESC guideline), only 19.7% of the high-risk and none of the very high-risk participants met these targets. In addition, a strong correlation regarding the estimated CVD risk was observed between the D:A:D (R) and ESC SCORE2/SCORE2-OP scores (r = 0.95). Conclusions: The achievement of guideline-recommended LDL-C targets was low in the high- and very high-CVD-risk groups in the DUALIS study, reflecting low utilization of LLT in clinical practice.