Substudy of REPRIEVE trial reveals how statin therapy prevents cardiovascular disease in people with HIV

BOSTON – A recent clinical trial reveals how a daily statin pill may prevent heart attacks and strokes in people with HIV. In this substudy of the phase 3 Randomized Trial to Prevent Vascular Events in HIV (REPRIEVE), a team led by investigators at Massachusetts General Hospital (MGH) discovered that pitavastatin reduces plaque buildup in the heart’s coronary arteries and lowers inflammation in the blood. The findings are published in JAMA Cardiology.

In REPRIEVE, pitavastatin—a cholesterol lowering medication with minimal interactions with anti-retroviral HIV therapy—reduced the risk of adverse cardiovascular events including heart attack and stroke by 35% over five years in 7,769 people with HIV.  The effect went beyond what would be expected from cholesterol lowering alone. In the REPRIEVE substudy, 611 people had computed tomography (CT) scans (to assess plaques in the coronary arteries) at both the start of the trial and after two years after randomization to pitavastatin or placebo. Blood markers of inflammation were also measured at baseline and after two years.

At the two-year mark, pitavastatin reduced noncalcified coronary plaque volume by 7% compared with placebo. Also, participants taking pitavastatin had a 33% lower risk of coronary plaque progression. Furthermore, pitavastatin led to reductions in oxidized low-density lipoprotein and lipoprotein-associated phospholipase A2, which are measures of lipid oxidation and arterial inflammation—processes that contribute to plaque formation and atherosclerosis.

“The reductions in coronary plaque and inflammation may help explain the prevention of cardiovascular events observed in REPRIEVE,” says lead author Michael T. Lu, MD, MPH, who is the co-director of the MGH Cardiovascular Imaging Research Center, associate chair of imaging science for the MGH Department of Radiology, and an associate professor of Radiology at Harvard Medical School. “This is also the largest trial to show that coronary CT angiography, a noninvasive test, can track changes in plaque in response to a drug.”

REPRIEVE’s results may have a clinical impact on national and international guidelines in the near future. The British HIV Association recently released guidelines recommending statins in people with HIV, Lu notes.

 

Additional MGH co-authors include Borek Foldyna, Markella V. Zanni, Thomas Mayrhofer, Julia Karady, Jana Taron, Kathleen V. Fitch, Sara McCallum, Kayla Paradis, Sandeep S. Hedgire, Nandini M. Meyersohn, Audra Sturniolo, Marissa Diggs, Udo Hoffmann, and Steven K. Grinspoon.

 

The REPRIEVE trial has been primarily funded by the National Heart, Lung and Blood Institute (NHLBI) with support from the National Institute of Allergy and Infectious Diseases (NIAID) and from the National Institutes of Health Office of AIDS Research, with additional support from Kowa Pharmaceuticals America, Inc. (including provision of study product), Gilead Sciences, and ViiV Healthcare.

 

 

About the Massachusetts General Hospital

Massachusetts General Hospital, founded in 1811, is the original and largest teaching hospital of Harvard Medical School. The Mass General Research Institute conducts the largest hospital-based research program in the nation, with annual research operations of more than $1 billion and comprises more than 9,500 researchers working across more than 30 institutes, centers and departments. In July 2022, Mass General was named #8 in the U.S. News & World Report list of "America’s Best Hospitals." MGH is a founding member of the Mass General Brigham healthcare system.

 

 

https://www.bhiva.org/BHIVA-rapid-guidance-on-the-use-of-statins-for-primary-prevention-of-cardiovascular-disease