Statins Show Promise in Reducing Cardiovascular Risks for People with HIV

A study supported by the National Institute of Health has revealed that statins, a class of cholesterol-lowering medications, may significantly reduce the high risk of cardiovascular disease in people living with HIV by more than a third. This finding has the potential to prevent one in five major cardiovascular events or premature deaths in this vulnerable population, as people living with HIV can face a 50-100% increased risk of cardiovascular disease. 

Published in the New England Journal of Medicine, the study suggests that statins could offer an accessible and cost-effective measure to improve cardiovascular health and quality of life for people with HIV. The National Heart, Lung, and Blood Institute (NHLBI), one of the study’s funders, expresses hope that further research will expand on this effect and lead to swift implementation in clinical practice. 

The phase 3 trial, known as the Randomized Trial to Prevent Vascular Events in HIV (REPRIEVE) study, conducted double-blinded randomizations of participants. Some received daily statin treatment, specifically pitavastatin calcium, while others received a placebo pill with no active medication. Over the course of approximately five years, researchers monitored the participants but ended the trial prematurely when they discovered the treatment benefits far outweighed potential risks. 

The results showed that participants who received daily pitavastatin experienced 35% fewer major cardiovascular events, including heart attacks, strokes, or surgeries to open blocked arteries, compared to those who received the placebo. Additionally, the treatment group had a 21% lower likelihood of experiencing a combination of major cardiovascular events and deaths during the study period. Furthermore, pitavastatin reduced low-density lipoprotein (LDL) cholesterol levels by 30%. 

Dr. Steven K. Grinspoon, the study chair and a professor of medicine at Harvard University, noted that while lowering LDL cholesterol levels reduces cardiovascular risks, these findings suggest that statin therapy may have additional benefits for people with HIV. Ongoing research is exploring how statin therapy may impact inflammation and increased immune activation in HIV patients, shedding light on these additional benefits. 

To ensure optimal health outcomes among study participants, researchers required enrollees to have normal liver and kidney function and to undergo antiretroviral therapy. The latter is critical in reducing the risk of HIV complications and related comorbidities, including cardiovascular disease. 

The REPRIEVE study, initiated in 2015, enrolled 7,769 adults between the ages of 40 and 75 from 145 sites in 12 countries. The average age of study participants was 50, and they had low-to-moderate risks for cardiovascular disease, meaning they would not typically have been prescribed statins. Women accounted for 31% of participants, and various racial backgrounds were represented, with approximately 41% identifying as Black, 35% as White, 15% as Asian, and 9% as another race. 

While the study has shown promising results, the researchers stress the need for further investigations to determine how these findings will impact guidelines for the care of people living with HIV. Dr. Hugh Auchincloss, acting director of the National Institute of Allergy and Infectious Diseases (NIAID), the study sponsor, emphasizes the global importance of addressing comorbidities like cardiovascular diseases that afflict people with HIV. As HIV management has become more successful, it has become essential to focus on related health conditions. 

According to the World Health Organization, over 38 million people worldwide are living with HIV, a virus that suppresses the body’s immune system if left untreated. In 2021 alone, around 1.5 million new HIV cases were diagnosed, highlighting the ongoing significance of research and advancements in treating and preventing HIV-related conditions.