B0498 - Statin Utilization as a Function of Calculated ASCVD Risk in HCV-Infected Patients

Monday, October 24, 2022

10:00 AM – 12:00 PM ET

Location: Crown Ballroom

Presenting Author(s)

Spencer Goble, MD

Hennepin County Medical Center (HCMC)
Minneapolis, MN

Spencer Goble, MD¹, Philippe Nyembo, MBChB¹, Brian Goodroad, DNP, RN, CNP², George Konstantinides, PharmD, BCPS, AAHIVP¹, Amanda J. Noska, MD, MPH³
¹Hennepin County Medical Center (HCMC), Minneapolis, MN; ²Hennepin Healthcare, Minneapolis, MN; ³Hennepin County Medical Center (HCMC), University of Minnesota, Minneapolis, MN

Introduction: HCV infection is an independent risk factor for cardiovascular disease (CVD). Statins remain underutilized in this population despite increasing evidence that they are safe to use in chronic, stable liver disease. Recently, Chew et al examined the use of the Pooled Cohort Equation in HCV-infected veterans and found that it overestimated risk in individuals with calculated risk < 7.5%, but underestimated risk in those with calculated risk ≥ 7.5%. We aimed to assess statin utilization as a function of calculated ASCVD risk score in HCV-infected individuals to further understand the implications of the inaccuracies with the Pooled Cohort Equation in estimating CVD risk in this population.

Methods: We performed a single-center retrospective study of HCV-infected individuals aged 40-75 years. The 10-year ASCVD risk score was calculated for each subject using the 2013 American College of Cardiology/American Heart Association Pooled Cohort Equation. Statin use was determined by review of prescribed medications from 2019-2021.

Results: A total of 1,077 subjects were included in analysis. The proportions of subjects being treated with a statin were calculated for ASCVD risk groups of < 5%, 5-7.4%, 7.5-9.9%, 10-19.9% and ≥ 20%. Statins were prescribed in 19/237 (8.0%), 18/131 (13.7%), 23/98 (23.5%), 112/361 (31.0%), and 134/250 (53.6%) respectively. For individuals with a 10-year risk ≥ 7.5%, a total of 269/709 (37.9%) were treated with a statin.

Discussion: Our results indicate that while statin utilization appropriately increases among HCV-infected individuals as 10-year ASCVD risk score increases, statins remain underutilized even in very high-risk individuals. With recent literature suggesting that the Pooled Cohort Equation underestimates CVD risk in HCV-infected individuals with a risk ≥ 7.5%, the importance of increasing efforts to increase statin use for primary CVD prevention in these patients is clear. Considerable retrospective data and limited prospective data are available that support the safety of statins in chronic liver disease, including compensated cirrhosis. Further prospective study to assure the safety and efficacy of statins in preventing CVD in HCV-infected population is warranted.

Chew KW, Bhattacharya D, Horwich TB, Yan P, McGinnis KA, Tseng C, et al. Performance of the Pooled Cohort atherosclerotic cardiovascular disease risk score in hepatitis C virus-infected persons. J Viral Hepat. 2017;24(10):814-22.

Variable	ASCVD risk < 5% (n=237)	ASCVD risk 5-7.4% (n=131)	ASCVD risk 7.5-9.9% (n=98)	ASCVD 10-19.9% (n=361)	ASCVD risk ≥ 20% (n=250)	P-value
Age (years), mean (SD)	49.5 (6.3)	54.5 (6.0)	56.1 (6.4)	59.6 (6.1)	61.7 (6.0)	< 0.001
Female sex	65.0%	42.0%	38.8%	30.5%	17.6%	< 0.001
Black race	24.1%	25.2%	44.9%	54.8%	73.6%	< 0.001
Total cholesterol (mg/dL), mean (SD)	166.7 (35.8)	169.4 (42.5)	172.9 (36.3)	169.8 (36.7)	168.0 (42.9)	0.704
High-density lipoprotein cholesterol (mg/dL), mean (SD)	59.1 (20.5)	56.7 (20.2)	55.9 (20.0)	52.3 (18.0)	50.6 (19.6)	< 0.001
Low-density lipoprotein cholesterol (mg/dL), mean (SD)	73.1 (39.6)	73.6 (40.8)	83.4 (42.4)	77.6 (41.8)	75.9 (39.8)	0.266
Diabetes	9.7%	15.3%	27.6%	25.5%	65.2%	< 0.001
Systolic blood pressure (mmHg), mean (SD)	122.1 (14.4)	125.6 (17.9)	126.3 (17.7)	135.4 (17.1)	145.7 (18.8)	< 0.001
On anti-hypertensive therapy	36.3%	48.9%	51.0%	62.9%	85.2%	< 0.001
Body mass index (kg/m²), mean (SD)	28.8 (7.2)	29.4 (7.0)	29.5 (7.1)	28.6 (6.7)	29.2 (6.5)	0.652
Current smoking	43.5%	59.5%	54.1%	59.8%	68.4%	< 0.001
FIB-4 > 3.5	13.7%	14.2%	9.6%	14.7%	9.3%	0.286
Diagnosis of cirrhosis	13.5%	13.7%	19.4%	16.1%	15.6%	0.689
Statin therapy	8.0%	13.7%	23.5%	31.0%	53.6%	< 0.001

Table: Characteristics of Subjects for Each Evaluated ASCVD Risk Group

Disclosures:

Spencer Goble indicated no relevant financial relationships.

Philippe Nyembo indicated no relevant financial relationships.

Brian Goodroad indicated no relevant financial relationships.

George Konstantinides indicated no relevant financial relationships.

Amanda Noska indicated no relevant financial relationships.

Spencer Goble, MD¹, Philippe Nyembo, MBChB¹, Brian Goodroad, DNP, RN, CNP², George Konstantinides, PharmD, BCPS, AAHIVP¹, Amanda J. Noska, MD, MPH³. B0498 - Statin Utilization as a Function of Calculated ASCVD Risk in HCV-Infected Patients, ACG 2022 Annual Scientific Meeting Abstracts. Charlotte, NC: American College of Gastroenterology.