Daily statin reduces the risk of cardiovascular disease in HIV

Cardiovascular system

A National Institutes of Health (NIH) clinical trial was stopped early because a daily statin medication was found to reduce the increased risk of cardiovascular disease among people living with HIV.

This was the first large-scale clinical study to test a primary cardiovascular prevention strategy in this population.

Advances in HIV treatment have drastically reduced AIDS-related complications and deaths. However, as people with HIV live longer, premature heart disease and other chronic conditions have emerged as leading causes of morbidity and mortality. This contributes to persistent gaps in lifespan between people with HIV and the broader population.

“The REPRIEVE study reflects the evolution of HIV science, and progress from focusing mostly on approaches to treat and control the virus to finding ways to improve the overall health of people living with HIV,” said acting NIAID Director Hugh Auchincloss. “These new data suggest that a common cholesterol-lowering medicine could substantially improve cardiovascular outcomes in people with HIV.”

The REPRIEVE trial

A planned interim analysis of data from the Randomized Trial to Prevent Vascular Events in HIV (REPRIEVE) study found that participants who took pitavastatin calcium, a daily statin, lowered their risk of major adverse cardiovascular events by 35% compared with those receiving a placebo.

Adverse drug events observed in the study were like those in the general population taking statin therapy.

The interim analysis was sufficiently compelling that the study’s independent Data Safety and Monitoring Board (DSMB) recommended it be stopped early given adequate evidence of efficacy and the NIH accepted the recommendations.

REPRIEVE began in 2015 and enrolled 7,769 volunteers who were 40 to 75 years of age, of whom more than 30% were women.

REPRIEVE volunteers were all taking antiretroviral therapy, with CD4+ cell counts greater than 100 cells/mm3 of blood at enrolment, and had low-to-moderate traditional cardiovascular disease risk that would not typically be considered for statin treatment.

The trial was conducted in 12 countries in Asia, Europe, North America, South America and Africa.

Study results from the DSMB review are expected to be published in the coming weeks.

“These latest findings represent the culmination of an unprecedented eight-year effort to generate evidence that can help clinicians better support the unique cardiovascular health needs of people living with HIV,” said NHLBI Director Gary H Gibbons. “REPRIEVE is important because there are limited existing interventions to help prevent adverse cardiovascular outcomes in this population.”

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