February 28, 2024
2 min read
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Key takeaways:
- People with HIV have double the risk for cardiovascular disease and develop it a decade earlier than the general population.
- New HHS guidelines recommend some people with HIV start statins as young as age 40.
An HHS panel recommended this week that people with HIV begin taking a statin as young as age 40 years to lower their risk for a serious cardiac event, even if their risk for heart disease is in the low-to-moderate range.
The HHS Panel for the Use of Antiretroviral Agents in Adults and Adolescents with HIV collaborated on the guidance with the HIV Medicine Association, the American College of Cardiology and the American Heart Association.
New guidance recommends that people with HIV with a low-to-intermediate 10-year risk for cardiovascular disease should receive statin therapy. Image: Adobe Stock
Since 1996, as fewer people with HIV have died of AIDS-related reasons, cardiovascular and heart-related mortality has become a greater concern. After starting on ART, people with HIV may gain weight, which can increase longer term health risks.
“People with HIV have about a twofold increased risk of cardiovascular disease and develop the disease about a decade earlier than the general population,” Allison Agwu, MD, ScM, FIDSA, FAAP, chair of the HIV Medicine Association, said in a statement.
Evidence has shown, however, that taking a daily statin can lower cardiovascular disease risk among people with HIV by more a one-third.
The panel’s recommendations were based on results from the phase 3 REPRIEVE trial, a global randomized controlled trial of oral daily pitavastatin vs. placebo in people aged 40 to 75 years with low-to-intermediate 10-year risk for atherosclerotic cardiovascular disease (ASCVD). Compared with placebo, pitavastatin was associated with a 35% reduction in risk for cardiovascular-related or undetermined cause of death.
The panel recommended that people with HIV aged 40 to 75 years with a low-to-intermediate 10-year risk for ASCVD — estimated at 5% to 19% — receive at least moderate-intensity statin therapy. The options for this therapy include once-daily doses of 4 mg of pitavastatin, 20 mg of atorvastatin or 10 mg rosuvastatin.
The panel said it “favors” at least moderate-intensity statin therapy for patients aged 40 to 75 years whose 10-year ASCVD risk estimates are below 5%, but made no recommendation for anyone aged younger than 40 years due to insufficient data.
Previous guidelines already recommend statins for all people at high risk for ASCVD, including people with HIV.
Following the new guidance “could dramatically reduce serious cardiovascular events among people with HIV,” Agwu said.
“[The HIV Medical Association] encourages the clinician community to review and quickly adopt the guidance to help people with HIV stay healthy and thrive as they age,” Agwu said.
References:
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