Adults with HIV can lower risk for cardiovascular disease with daily statin, study finds
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Key takeaways:
- HIV is considered a risk factor for cardiovascular disease.
- Taking a daily statin can lower the risk by more than one-third.
Adults with HIV can lower their risk for serious cardiovascular events like heart attack or stroke by more than one-third if they take a daily statin, a large phase 3 trial found.
The REPRIEVE trial compared cardiovascular events among thousands of people with HIV who took either pitavastatin calcium or a placebo every day. Results were published Sunday in The New England Journal of Medicine and presented at the biennial conference of the International AIDS Society (IAS).
The NIH, which funded the trial, announced in April that it had been stopped early after an interim analysis showed the effectiveness of statin therapy when taken daily by adults with HIV.
“This research suggests that statins may provide an accessible, cost-effective measure to improve the cardiovascular health and quality of life for people living with HIV,” Gary H. Gibbons, MD, director of the NIH’s National Heart, Lung, and Blood Institute, said in a statement. “Additional research can further expand on this effect, while providing a road map to rapidly translate research findings into clinical practice.”
Over the years, highly effective ART has narrowed the life expectancy gap between people with HIV and the general population — perhaps even to zero among people who begin treatment soon after infection. But as a patient’s age increases, so does their risk for comorbidities, past research has shown.
HIV has been considered a risk factor for cardiovascular disease for years, REPRIEVE study chair Steven K. Grinspoon, MD, told reporters on a call ahead of the IAS conference. According to the NIH, having HIV can increase a person’s risk for cardiovascular disease by up to 100%.
“The problem is, no one knew what to do with that information,” said Grinspoon, a professor of medicine at Harvard University and chief of the metabolism unit at Massachusetts General Hospital. “People were not necessarily prescribing statins, even though HIV was considered a risk modifier, because there had been no data to show that it was efficacious.”
Grinspoon and colleagues enrolled more than 7,700 people from 12 countries with low-to-moderate risk for cardiovascular disease and randomly assigned them to take either daily pitavastatin calcium at 4 mg per dose or placebo.
Study participants were diverse — approximately 65% were not white and around 31% were women — and lived in countries “in every kind” of gross domestic product range, Grinspoon said. Their median age was 50 years, and among those with available data, around 87% were virally suppressed.
The trial was stopped after a median follow-up of 5.1 years. In that time, the median incidence of a major adverse cardiovascular event per 1,000 person-years was 4.81 in the treatment group and 7.32 in the placebo group, a reduction of 35% (HR = 0.65; 95% CI, 0.48-0.9).
Among secondary outcomes, the incidence of a major adverse cardiovascular event or death from any cause was reduced by 21% in the treatment group (HR = 0.79; 95% CI, 0.65-0.96), the researchers reported.
The data suggest “that guidelines should be amended to recommend that HIV patients ... be offered a statin therapy, even at low-to-moderate risk” for cardiovascular disease, Grinspoon said.
References:
- Grinspoon SK, et al. Key REPRIEVE results and the utility of statins among people living with HIV: What have we learned? Presented at: International AIDS Society Conference on HIV Science; July 23-26, 2023; Brisbane, Australia.
- Grinspoon SK, et al. N Engl J Med. 2023;doi:10.1056/NEJMoa2304146.
Perspective
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REPRIEVE was an ambitious, large, international trial designed to ask whether the use of lipid-lowering statin therapy in persons with HIV could lower the rate of cardiovascular disease, even in those who hadn't met the usual indications for such medications. This was designed to explore the possible independent role of HIV infection in causing heart disease and the effect of statins in addition to HIV treatment itself in improving clinical outcomes.
The trial was extremely well organized and carefully conducted. The final results showed that, compared with placebo, the lipid treatment (with the statin pitavastatin) indeed lowered the risk for cardiovascular endpoints by about 35%, paving the way to recommend lipid treatment in many persons with HIV infection, further improving the care of our patients. This is an important advance in HIV care.
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Grinspoon S, et al. Key REPRIEVE results and the utility of statins among people living with HIV: What have we learned? Presented at: International AIDS Society Conference on HIV Science; July 23-26, 2023; Brisbane, Australia.
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