Statins to improve cardiovascular outcomes in treated HIV infection

Abstract

Purpose of review To evaluate evidence that statins reduce cardiovascular risk in patients living with HIV Recent findings Moderate to high dose atorvastatin and rosuvastatin appear to reduce non-calcified coronary plaque volume and slow progression of carotid intima-media thickness in patients with treated HIV infection. Expected lipoprotein changes with statins on the background of modern ART are similar to the general population. In addition to lipids, the statin benefit may be mediated in part by improvements in vascular inflammation and levels of T-cell and monocyte activation. One concern is the potential for rosuvastatin to cause insulin resistance. Decisions to prescribe statins must be done in the context of global risk assessment, but traditional risk calculators such as the Framingham risk score or the ACC/AHA pooled-risk equations underestimate risk in this population. Furthermore, many patients with subclinical disease would not be recommended for statins according to the most recent ACC/AHA guidelines. Summary Statins are likely to improve cardiovascular outcomes for patients with HIV, but results of the first outcome study are not expected until 2020. In the meantime, clinicians should individualize statin prescriptions, and should consider using more potent statins (rosuvastatin, atorvastatin, and pitavastatin) when possible.

Cholesterol Screening and Statin Prescription is Low Among HIV-Infected Patients on Protease-Inhibitor Regimens in Botswana

“…Despite this established association between CVD risk and HIV-infection, adherence to CVD risk factor screening is often low among HIV providers in high resource settings [ 5 ]. Of note, hypercholesterolemia among HIV-infected patients can be effectively managed using statin therapy [ 6 ]. Additionally, statin therapy among HIV-infected patients have been associated with favourable changes in immune dysregulation such as decrease in T-cell activation and exhaustion plus lowering of biomarkers of vascular inflammation [ 7 , 8 ].…”

“…The on-going National Institute of Health (NIH) sponsored multisite Randomized Trial to Prevent Vascular Events in HIV (REPRIEVE) will assess whether statin therapy is associated with decrease in CVD events in this population [ 9 ]. Since the results are pending from REPRIEVE, major guidelines on HIV care recommend screening for cholesterol and treating hypercholesterolemia with statins [ 6 ].…”

Subclinical atherosclerosis in low Framingham risk HIV patients

“…The point is that these scores may underestimate the real risk in the HIV population as has been suggested by cohort studies , and some patients currently considered as low risk have actually a moderate risk and should be considered for a more aggressive control of CVRF. The use of statins as primary prevention of cardiovascular events in patients at low risk is not currently recommended; however, these drugs have been shown to reduce noncalcified coronary plaque volume and to slow progression of CIMT , so, in the absence of conclusive clinical data, statins use in HIV patients with subclinical atherosclerosis based on the ultrasound carotid plaque composition need to be studied.…”

“…HIV-related variables CVRF. The use of statins as primary prevention of cardiovascular events in patients at low risk is not currently recommended; however, these drugs have been shown to reduce noncalcified coronary plaque volume and to slow progression of CIMT [24,25], so, in the absence of conclusive clinical data, statins use in HIV patients with subclinical atherosclerosis based on the ultrasound carotid plaque composition need to be studied.…”

Lipid Abnormalities and Inflammation in HIV Inflection

“…Perturbations in lipid profiles and the increased risk for CVD reported in chronic HIV infection[1, 4, 6-8, 97] has generated significant interest in modulating lipid levels and inflammation in HIV+ persons, especially though the use of statins (3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors)[98]. The effects of statin use among HIV infected individuals has recently been reviewed[99], and overall, statin use was well-tolerated and improved lipid profiles.…”