Association of Cardiologist Clinic Visits With Cardiovascular Primary Prevention Outcomes Among People With HIV From Underrepresented Racial and Ethnic Groups in the Southern United States
Background People with HIV (PWH) have elevated cardiovascular risk. Underrepresented racial and ethnic groups in the southern United States are disproportionately affected, yet whether cardiology care for this at‐risk group improves blood pressure and lipid control or prevents cardiovascular events...
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| Language: | English |
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Wiley
2025-03-01
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| Series: | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
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| Online Access: | https://www.ahajournals.org/doi/10.1161/JAHA.124.038462 |
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| author | Matthew S. Durstenfeld C. Larry Hill Robert M. Clare Karen Chiswell Gretchen Sanders Shamea Gray Joseph Vicini Keith Marsolo Nwora Lance Okeke Eric G. Meissner Kevin L. Thomas Caryn G. Morse Gerald S. Bloomfield April C. Pettit Chris T. Longenecker |
| author_facet | Matthew S. Durstenfeld C. Larry Hill Robert M. Clare Karen Chiswell Gretchen Sanders Shamea Gray Joseph Vicini Keith Marsolo Nwora Lance Okeke Eric G. Meissner Kevin L. Thomas Caryn G. Morse Gerald S. Bloomfield April C. Pettit Chris T. Longenecker |
| author_sort | Matthew S. Durstenfeld |
| collection | DOAJ |
| description | Background People with HIV (PWH) have elevated cardiovascular risk. Underrepresented racial and ethnic groups in the southern United States are disproportionately affected, yet whether cardiology care for this at‐risk group improves blood pressure and lipid control or prevents cardiovascular events is unknown. Methods and Results We evaluated a cohort of PWH from underrepresented racial and ethnic groups who received HIV‐related care at 4 centers in the southern United States during 2015 to 2018 with follow‐up through 2020. Primary outcomes were blood pressure control (<140/90 mm Hg) and lipid control (low‐density lipoprotein cholesterol ≤100 mg/dL) over 2 years and time to first major adverse cardiovascular event. Statistical analyses were adjusted for cohort/site and patient sociodemographic factors, HIV measures, and comorbidities. Among 3972 included PWH (median age, 47 years; 32.6% women) without diagnosed cardiovascular disease, 276 (6.9%) had a cardiology clinic visit. Cardiology visits were not associated with subsequent blood pressure control (adjusted odds ratio, 0.78 [95% CI, 0.49–1.24]; P=0.29) or lipid control (adjusted odds ratio, 2.25 [95% CI, 0.72–7.01]; P=0.16). Over 5‐year follow‐up, patients who had a cardiology visit had a higher risk of a major adverse cardiovascular event, death, and falsification end points, even after adjusting for measured risk factors. Conclusions Among PWH from underrepresented racial and ethnic groups at elevated risk for cardiovascular disease, a cardiology clinic visit was not associated with risk factor improvement or reduced risk of a major adverse cardiovascular event. Our study suggests that seeing a cardiologist is not sufficient to promote cardiovascular health or prevent cardiovascular events among PWH, but with low confidence given the higher risk among those who had a cardiology visit. |
| format | Article |
| id | doaj-art-811f0fa39aec4f33a0b739fe15d0bfd5 |
| institution | OA Journals |
| issn | 2047-9980 |
| language | English |
| publishDate | 2025-03-01 |
| publisher | Wiley |
| record_format | Article |
| series | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| spelling | doaj-art-811f0fa39aec4f33a0b739fe15d0bfd52025-08-20T02:02:50ZengWileyJournal of the American Heart Association: Cardiovascular and Cerebrovascular Disease2047-99802025-03-0114610.1161/JAHA.124.038462Association of Cardiologist Clinic Visits With Cardiovascular Primary Prevention Outcomes Among People With HIV From Underrepresented Racial and Ethnic Groups in the Southern United StatesMatthew S. Durstenfeld0C. Larry Hill1Robert M. Clare2Karen Chiswell3Gretchen Sanders4Shamea Gray5Joseph Vicini6Keith Marsolo7Nwora Lance Okeke8Eric G. Meissner9Kevin L. Thomas10Caryn G. Morse11Gerald S. Bloomfield12April C. Pettit13Chris T. Longenecker14Division of Cardiology at Zuckerberg San Francisco General University of California San Francisco San Francisco CA USADuke Clinical Research Institute Durham NC USADuke Clinical Research Institute Durham NC USADuke Clinical Research Institute Durham NC USADuke Clinical Research Institute Durham NC USADepartment of Medicine Duke University School of Medicine Durham NC USADepartment of Medicine Vanderbilt University Medical Center Nashville TN USADuke Clinical Research Institute Durham NC USADepartment of Medicine Duke University School of Medicine Durham NC USADivision of Infectious Diseases, Department of Microbiology and Immunology Medical University of South Carolina Charleston SC USADepartment of Medicine Duke University School of Medicine Durham NC USADivision of Infectious Diseases Wake Forest Baptist Health Winston‐Salem NC USADuke Clinical Research Institute Durham NC USADepartment of Medicine Vanderbilt University Medical Center Nashville TN USADivision of Cardiology & Department of Global Health University of Washington Seattle WA USABackground People with HIV (PWH) have elevated cardiovascular risk. Underrepresented racial and ethnic groups in the southern United States are disproportionately affected, yet whether cardiology care for this at‐risk group improves blood pressure and lipid control or prevents cardiovascular events is unknown. Methods and Results We evaluated a cohort of PWH from underrepresented racial and ethnic groups who received HIV‐related care at 4 centers in the southern United States during 2015 to 2018 with follow‐up through 2020. Primary outcomes were blood pressure control (<140/90 mm Hg) and lipid control (low‐density lipoprotein cholesterol ≤100 mg/dL) over 2 years and time to first major adverse cardiovascular event. Statistical analyses were adjusted for cohort/site and patient sociodemographic factors, HIV measures, and comorbidities. Among 3972 included PWH (median age, 47 years; 32.6% women) without diagnosed cardiovascular disease, 276 (6.9%) had a cardiology clinic visit. Cardiology visits were not associated with subsequent blood pressure control (adjusted odds ratio, 0.78 [95% CI, 0.49–1.24]; P=0.29) or lipid control (adjusted odds ratio, 2.25 [95% CI, 0.72–7.01]; P=0.16). Over 5‐year follow‐up, patients who had a cardiology visit had a higher risk of a major adverse cardiovascular event, death, and falsification end points, even after adjusting for measured risk factors. Conclusions Among PWH from underrepresented racial and ethnic groups at elevated risk for cardiovascular disease, a cardiology clinic visit was not associated with risk factor improvement or reduced risk of a major adverse cardiovascular event. Our study suggests that seeing a cardiologist is not sufficient to promote cardiovascular health or prevent cardiovascular events among PWH, but with low confidence given the higher risk among those who had a cardiology visit.https://www.ahajournals.org/doi/10.1161/JAHA.124.038462cardiovascular diseases specialtyHIVoutcomesprimary prevention |
| spellingShingle | Matthew S. Durstenfeld C. Larry Hill Robert M. Clare Karen Chiswell Gretchen Sanders Shamea Gray Joseph Vicini Keith Marsolo Nwora Lance Okeke Eric G. Meissner Kevin L. Thomas Caryn G. Morse Gerald S. Bloomfield April C. Pettit Chris T. Longenecker Association of Cardiologist Clinic Visits With Cardiovascular Primary Prevention Outcomes Among People With HIV From Underrepresented Racial and Ethnic Groups in the Southern United States Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease cardiovascular diseases specialty HIV outcomes primary prevention |
| title | Association of Cardiologist Clinic Visits With Cardiovascular Primary Prevention Outcomes Among People With HIV From Underrepresented Racial and Ethnic Groups in the Southern United States |
| title_full | Association of Cardiologist Clinic Visits With Cardiovascular Primary Prevention Outcomes Among People With HIV From Underrepresented Racial and Ethnic Groups in the Southern United States |
| title_fullStr | Association of Cardiologist Clinic Visits With Cardiovascular Primary Prevention Outcomes Among People With HIV From Underrepresented Racial and Ethnic Groups in the Southern United States |
| title_full_unstemmed | Association of Cardiologist Clinic Visits With Cardiovascular Primary Prevention Outcomes Among People With HIV From Underrepresented Racial and Ethnic Groups in the Southern United States |
| title_short | Association of Cardiologist Clinic Visits With Cardiovascular Primary Prevention Outcomes Among People With HIV From Underrepresented Racial and Ethnic Groups in the Southern United States |
| title_sort | association of cardiologist clinic visits with cardiovascular primary prevention outcomes among people with hiv from underrepresented racial and ethnic groups in the southern united states |
| topic | cardiovascular diseases specialty HIV outcomes primary prevention |
| url | https://www.ahajournals.org/doi/10.1161/JAHA.124.038462 |
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