Evolving Role of Statins in Managing CV Risk in HIV | ID Week 2024

The role of statins in managing cardiovascular risk for people living with HIV, particularly those aged 40 to 75, has been evolving, explained Michelle Cespedes, M.D., M.S., professor of medicine, Icahn School of Medicine at Mount Sinai and Mount Sinai Health System.

Traditionally, statins have been viewed as cholesterol-lowering agents, but they have been found to possess anti-inflammatory properties that can benefit patients beyond their lipid-lowering effects. This shift in understanding has prompted researchers to explore statins' potential in reducing cardiovascular events in the HIV population, which experiences heightened cardiovascular disease risk earlier than the general population.

The Reprieve Study, a pivotal research initiative, focused on individuals with HIV who did not meet conventional criteria for statin therapy. The study randomized participants to receive either pitavastatin — chosen for its lack of drug-drug interactions with common HIV medications — or a placebo. Results revealed a significant 35% reduction in major cardiovascular events, such as heart attacks and strokes, among those receiving pitavastatin.

“Even though that information just came out a year and a half ago, it's actually already changed guidelines around the world,” Cespedes said. “One of the things that is now recommended is that if someone with HIV is in this age group and meets the other criteria, which is practically all of our patients over 40 [years], it's recommended that they should be on what's called a moderate intensity statin.”

Cespedes emphasized that the primary concern for HIV patients has shifted from opportunistic infections to premature cardiovascular disease. The integration of statin therapy into standard care protocols reflects a proactive approach to mitigating cardiovascular risks and enhancing overall longevity for this population. As guidelines continue to evolve, healthcare providers are encouraged to consider statin therapy for their HIV patients, aligning treatment strategies with the latest evidence to improve health outcomes.

She also discussed research into other anti-inflammatory options, but she noted there has been a lack of data.