elevated cardiac risk score by ascvd calculation is associated with albuminuria...
TRANSCRIPT
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Elevated Cardiac Risk Score by ASCVD Calculation is Associated with Albuminuria in Older People Living with HIV
Carrie Johnston, MD, Kene Ifeagwu, Eugenia Siegler MD, Heather
Derry, PhD, Chelsie Burchett, Michelle Rice, Mary Choi, MD,
Marshall Glesby, MD, PhD.
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No Conflicts of Interest
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Increased Non-Communicable Disease
Burden in Adults with HIV
Schouten, J. et al. Cross-sectional Comparison of the Prevalence of Age
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• Greater decrease in GFR in
older PLWH compared to HIV-
controls2
• Faster fall with albuminuria
Living with HIV can increase the risk of cardiac and
kidney disease
• 1.5-2x risk of coronary heart disease1
1)Arnett et al., 2019 ACC/AHA Guideline on the Primary Prevention of Cardiovascular Disease2) American journal of nephrology (2019): 1-10
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In Older People with HIV:
1) Presence of albuminuria is related to
elevated atherosclerotic cardiovascular
disease (ASCVD) risk scores
2) Those with elevated cardiac risk may be
under-treated with statin medications
Hypotheses
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Methods: Cross-Sectional Study
Clinical Visit: BP Measurement, Waist Circumference, Psychosocial Survey, Frailty testing and MoCA
EMR Clinical Data:Medications, labs, diagnosis codes
Blood and Urine collected: Measurement of Urine Albumin, Urine Creatinine
Body composition analysis
Random Sample from HIV Clinic >50 years old
Participants >55 years old invited to Substudy
Study Enrollment
ROAH 2.0 Survey Visit
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Methods: Atherosclerotic Cardiovascular Disease (ASCVD)
Risk Score Calculation
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Score >7.5% = “Elevated Cardiac Risk”
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Methods: GFR Calculation
• CKD-Epi Equation:
- Accuracy across a range
of Glomerular Filtration
Rates
- Less underestimation of
GFR in subjects with
normal renal function
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Florkowski, CM. Clin Biochem Rev. 2011 May; 32(2): 75–79
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Methods: Urine Albumin:Creatinine Measurement
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“Chapter 1: Definition and classification of CKD.” Kidney international supplements vol. 3,1 (2013): 19-62.
Albuminuria 3 Levels
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Results: Study Participants (N=164)
• Age range 55-78 years (mean 61, SD 6)
• Median Time Living with HIV 25 years (IQR 22-29)
• 93% with HIV-1 Viral Load <200 copies/ml
• CD4: median 582 (IQR 402-795)
Sex Self-Identified Race
Black/African American/Caribbean
White/Caucasian
Other
FemaleMale
AfricanAmericanWhite
Other
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Cardiac Risk: Median ASCVD Score of 10.4% IQR(6-15)11
Elevated Risk >7.5% Study Median
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GFR Relatively Preserved, Notable Albuminuria12
Median GFR: 75 (IQR 60-91)
*p=0.002
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No Significant Differences in Albuminuria by TDF,
TAF or ACE/ARB Use
Moderate-Severe Elevation in Albuminuria by Medication Use (vs Non-Use)
Tenofovir disoproxilfumarate (TDF)
No significantdifference (p=0.32)
Tenofovir alafenamide(TAF)
No significant difference (p=0.26)
Angiotensin Converting Enzyme (ACEi) or Angiotensin II receptor blockers (ARB)
No significantdifference (p=0.32)
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• Median ASCVD score was greater in
those with moderate-severe
albuminuria by two-sample Wilcoxon
rank-sum
o Sensitivity analysis restricted to
non-diabetics had similar findings
(p=0.052)
Elevated ASCVD Risk Score Related to Moderate-
Severe Albuminuria
*p=0.002
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• Among participants with Elevated
ASCVD score (>7.5%):
o 52% were on Statin
─ Those over age 65 (p<0.001) and
with diabetes (p=0.002) were
more likely to be on a statin
o 19% on Abacavir
Underuse of Statins for those with Elevated Cardiac Risk
0
10
20
30
40
50
60
70
80
90
Age
Statin Use by Age
0
10
20
30
40
50
60
70
80
90
DM Diagnosis
Statin Use by Diabetes
DM
(*p<0.001) (*p=0.002)
<65
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- Nearly a quarter (23%) had moderate-severely elevated albuminuria
- Over half (53%) with elevated ASCVD Score (>7.5%)
- Elevated ASCVD Risk related to albuminuria
Conclusions
Preservation of Renal
Function
• mAlb Screening
• ACE/ARB use
HIV Management
• ARV Selection
Cardiac Health
Optimization
• Statin Use
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Acknowledgements
ID Division:
Dr. Marshall Glesby
Dr. Kristen Marks
Dr. Trip Gulick
Geriatrics Division:
Dr. Eugenia Siegler
Chelsie Burchett
Dr. Heather Derry
Shoran Tamura
Study Participants
Dr. Mary Choi Laboratory:
Dr. Mary ChoiMichelle Rice
CTSC:
RNsKatie Hootman, RDLab Staff
Funding: CTSCNIH T-32Gilead Sciences
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1) Schouten, J. et al. Cross-sectional Comparison of the Prevalence of
Age-Associated Comorbidities and Their Risk Factors Between HIV-
Infected and Uninfected Individuals: The AGEhIV Cohort Study.
Clinical Infectious Diseases, Volume 59, Issue 12, 15 December
2014, Pages 1787–1797
2) Arnett et al., 2019 ACC/AHA Guideline on the Primary Prevention of
Cardiovascular Disease
3) Ascher, Simon B., et al. "Associations of urine biomarkers with kidney
function decline in HIV-infected and uninfected men." American
journal of nephrology (2019): 1-10.
4) Christopher M Florkowski and Janice SC Chew-Harris. Clin Biochem
Rev. 2011 May; 32(2): 75–79
References