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Standard risk calculations underestimate the risk of cardiovascular disease (CVD) among HIV-infected people in several groups, including Black people and cisgender women, according to a new federally funded study by the NIH. found.
This is new data presented at this week’s Conference on Retroviruses and Opportunistic Infections (CROI) in Denver, Colorado.
Researchers found that the incidence of cardiovascular events in many groups of people is lower than predicted, even considering that people with HIV have a higher overall risk of cardiovascular disease than people without HIV (PWH). I discovered something different. High-income regions of the world, including North America, South America, and Europe, have higher rates of cardiovascular events overall, with cisgender women experiencing approximately 2.5 times more events than expected and black participants experiencing Vascular event rates were more than 50% higher than expected.
The results are part of the REPRIEVE trial, which enrolled 7,769 people with HIV between the ages of 40 and 75 and was conducted on five continents. This is the largest trial investigating primary prevention of major cardiovascular events in PWH.
One novel aspect of this study was that the participant group was diverse in terms of race and gender. Participants were then assessed as having low to moderate risk for cardiovascular disease using the pooled Cohort Risk Equation (PCE) score. The primary analysis of the trial, published in 2023, showed that people with HIV who took pitavastatin calcium had a 35% lower risk of serious cardiovascular events compared to those who took a placebo.
These results led to the publication of recommendations for the use of statin therapy in HIV-infected individuals in the February 2024 HHS clinical practice guidelines. As demonstrated by these new analyses, data from trials continue to address gaps in knowledge regarding cardiovascular health in people with HIV.
A second association analysis defined risk factors that contribute to the occurrence of major cardiovascular events such as heart attack and stroke. Researchers assessed the risk contributing to these events using an analysis that considered a variety of factors. They found that the risk of experiencing a first major adverse cardiovascular event was higher for HIV-infected people in high-income areas. Over 50 years old. Black; current or former smoker. Have a family history of hypertension or early onset cardiovascular disease. or a detectable HIV viral load, i.e. the amount of HIV in the blood.
Research points
The results of these two analyzes show that while all people with HIV are at increased risk for cardiovascular events, the risk of cardiovascular events in some people may be underestimated by current standard tools used to measure risk. It is clear that this may have been the case. The researchers noted that both traditional and HIV-related risk factors are associated with an increased risk of cardiovascular disease in people with HIV. They suggested that modern tools are needed to facilitate accurate, high-quality care for the diverse population living with HIV. Importantly, these studies highlight the need for representative inclusion in clinical trials.
reference
The tool underestimates the risk of cardiovascular events in people with HIV. NIH press release. March 4, 2024. Accessed March 5, 2024.
https://www.nih.gov/news-events/news-releases/tools-underestimate-cardiovascular-event-risk-people-hiv
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