IN the United States, statin initiation for atherosclerotic cardiovascular disease (ASCVD) prevention remains strikingly low, even among individuals with a clear clinical indication, according to a new prospective observational study. Despite well-established guidelines, just 20% of participants eligible for statins started therapy within two years, with major disparities seen across race, sex, and comorbidities.
The study followed 842 men and 852 women from two major cohort studies, tracking statin use from 2014 to 2020 based on the 2013 ACC/AHA guidelines. Participants included both people living with HIV (PLWH) and demographically similar individuals without HIV but at increased cardiovascular risk.
Researchers found that HIV status did not significantly affect statin initiation, suggesting equitable prescribing practices between the two groups. However, disparities emerged elsewhere. Statin initiation was notably lower among Black participants, particularly Black men, who had an initiation rate of only 14.0% compared to 22.3% in non-Black men—a statistically significant gap (Difference: –8.3%; 95% CI: –13.8%, –2.8%).
Initiation was also influenced by the reason for statin indication. Participants with a history of ASCVD (men: 32.9%; women: 22.0%) or diabetes (men: 26.4%; women: 24.5%) were more likely to start statins than those identified solely by ≥7.5% 10-year ASCVD risk (men: 14.2%; women: 15.2%). Smokers were less likely to initiate therapy than non-smokers, while those with obesity and other comorbidities were more likely.
These findings highlight persistent gaps in implementing evidence-based care, particularly for patients at the intersection of racial and cardiovascular risk. With new guidelines expanding statin indications for PLWH, addressing barriers to treatment uptake, including systemic inequities and patient engagement, is essential for improving long-term cardiovascular outcomes.
Reference: Breger TL et al. Incidence of statin initiation among people with and without HIV in the US: a prospective observational study. Clin Infect Dis. 2025:ciaf207. doi: 10.1093/cid/ciaf207.
