A recent clinical trial has shown how taking a daily statin pill can prevent heart attacks and strokes in people with HIV. In this substudy of the Phase 3 Randomized Trial to Prevent Vascular Events in HIV (REPRIEVE), a team led by Massachusetts General Hospital (MGH) researchers found that pitavastatin reduced plaque buildup in the heart’s coronary arteries. , found to reduce inflammation in the blood. The survey results are JAMA Cardiology.

In REPRIEVE, pitavastatin, a cholesterol-lowering drug with minimal interactions with antiretroviral HIV therapy, reduced the risk of adverse cardiovascular events such as heart attack and stroke by 35% over five years in 7,769 people with HIV. decreased. The effects exceeded what would be expected from cholesterol reduction alone. In the REPRIEVE substudy, 611 people underwent computed tomography (CT) scans (to assess plaque in their coronary arteries) both at the start of the trial and 2 years after randomization to pitavastatin or placebo. Blood markers of inflammation were also measured at baseline and after 2 years.

At 2 years, pitavastatin reduced noncalcified coronary plaque volume by 7% compared with placebo. Also, participants taking pitavastatin had a 33% lower risk of coronary plaque progression. Additionally, pitavastatin resulted in reductions in oxidized low-density lipoprotein and lipoprotein-associated phospholipase A2, which are measures of lipid oxidation and arterial inflammation, processes that contribute to plaque formation and atherosclerosis.

“Reductions in coronary plaque and inflammation may help explain the prevention of cardiovascular events observed in REPRIEVE,” said Dr. said co-director and lead author Michael T. Lu, MD, MPH. He is a professor of imaging science in the MGH Department of Radiology and an associate professor of radiology at Harvard Medical School. “This is also the largest trial to show that coronary CT angiography, a non-invasive test, can track changes in plaque in response to drugs.”

The results of REPRIEVE may have clinical impact on national and international guidelines in the near future. Lu points out that the UK HIV Society recently published guidelines recommending the use of statins in people with HIV.