Background:
People with HIV (PWH) have a 2-fold increased risk of major adverse cardiovascular events (MACE). REPRIEVE showed pitavastatin reduced MACE by 35% among PWH with low-to-moderate traditional risk. Enhanced understanding of the relative contributions of traditional and HIV-specific risk factors (RF) to MACE may guide concomitant individual- and population-level preventive interventions.
Methods:
Analyses in the REPRIEVE population were performed for first MACE (including MI, TIA/stroke, revascularization, CV death), with median follow-up of 5.6 years through August 2023. Cox proportional hazards models stratified by randomized treatment group were used to account for treatment differences. Individual models adjusting for each entry RF were fit, and the strongest factors were then combined into a single multivariate adjusted model.
Results:
Among 7,769 participants, 31.1% were natal female and 65.2% non-White. Median age was 50 years, LDL 108 mg/dL, 10-year ASCVD risk score 4.5%, diabetes prevalence <1%, and CD4 621 cell/mm3. In unadjusted models, RF associated with a higher (P<0.05) risk of first MACE were: older age, male sex, residence in a high-income region, Black/African American race (within high-income regions), family history of premature CVD, current/former smoking, hypertension (HTN), BMI ≥30 kg/m2, fasting glucose ≥100 mg/dL, lower HDL, eGFR <90 mL/min/1.73 mm2, lower nadir CD4, and detectable HIV-1 RNA (VL). After full adjustment, effects of natal sex, BMI, glucose, eGFR, and nadir CD4 were no longer apparent (P>0.25). Risk for first MACE was higher for older individuals (50-59 and ≥60 vs. 40-49, HR’s: 1.98 and 2.11), as well as those with a family history of premature CVD (HR: 1.57), Black/African American race (vs. white race, within high-income regions HR: 1.75), current/former smoking (HR: 1.66), HTN (HR: 1.68), and detectable VL (HR 1.46), and lower for those with higher HDL-C (HR: 0.83). Individuals from a high-income region had a higher risk of first MACE vs. those from other regions, save for those from South Asia (Figure).
Conclusions:
Among a global primary prevention cohort of PWH, factors associated with first MACE after accounting for statin effect included modifiable RF of cigarette smoking, HTN, and detectable VL. A protective effect of female sex was not apparent. Additional work is needed to understand the higher risk of MACE associated with residence in a high-income region, particularly among Black/African American PWH.
