Statin use lowered risk of a major adverse cardiovascular event in people with HIV
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The risk of cardiovascular disease is up to two times higher in people with HIV compared to the general population without HIV. The proposed mechanisms behind this increased risk include residual inflammation and immune activation from HIV in addition to the traditional cardiovascular risk factors. The Randomized Trial to Prevent Vascular Events in HIV (REPRIEVE) was a phase 3 trial to test the use of a statin in the primary prevention of cardiovascular events in people with HIV at low to moderate risk of atherosclerotic cardiovascular disease. The trial results were reported in the New England Journal of Medicine.
People with HIV, aged 40 to 75, on stable antiretroviral therapy and with low to moderate risk of atherosclerotic cardiovascular disease were included in the trial. Those with statin use in the past 90 days or known atherosclerotic disease were excluded. Patients were randomized to receive either pitavastatin (4 mg daily) or a placebo. The primary outcome was a major cardiovascular event (which included cardiovascular death, myocardial infarction, unstable angina, stroke, transient ischemic attack, peripheral arterial ischemia, a revascularization procedure or death from an undetermined cause).
More than 7,700 people with HIV were enrolled, their median age was 50, 65.2% were non-White, and 31.1% were women. The trial was stopped early due to efficacy. The median follow-up was 5.1 years. The incidence of major adverse cardiovascular events was 4.81 per 1,000 person years in the pitavastatin group and 7.32 in the placebo group, indicating a hazard reduction of 35% (hazard ratio, 0.65; P = .002). Diabetes (1.13 per 100 person years in pitavastatin group versus 0.84 in the placebo group) and grade three or higher myalgias/myopathy (0.49 per 100 person years in the pitavastatin group versus 0.28 in the placebo group) were statistically more common in the pitavastatin group compared to the placebo group, but overall and serious nonfatal events were similar. These results support the use of pitavastatin (and possibly other statins) in the primary prevention of cardiovascular events in people with HIV on antiretroviral therapy.
