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Association between statin use, atherosclerosis, and mortality in HIV-infected adults
Binh An P Phan1, Yifei Ma1, Rebecca Scherzer2
1Division of Cardiology, San Francisco General Hospital, Department of Medicine, University of California, San Francisco, California, United States of America.
Insights
For HIV-infected adults at high cardiovascular risk, statins did not significantly reduce carotid artery intima-media thickness (cIMT) progression or all-cause mortality. Further research is needed to clarify the role of statins in managing cardiovascular risk in this population.
Area of Science:
- Cardiology
- Infectious Diseases
- Pharmacology
Background:
- HIV infection is linked to increased cardiovascular disease (CVD) risk.
- The efficacy of statin therapy in reducing CVD risk in HIV-infected adults remains unclear.
- This study investigates statins' impact on atherosclerosis progression and mortality in high-risk HIV patients.
Purpose of the Study:
- To evaluate the association between statin use and carotid artery intima-media thickness (cIMT) progression in HIV-infected adults.
- To assess the effect of statins on all-cause mortality in this patient group.
- To determine if statins benefit HIV-infected individuals meeting criteria for statin therapy.
Main Methods:
- A cohort of 127 HIV-infected adults meeting ACC/AHA criteria for statins was studied.
- Carotid IMT was measured at baseline and follow-up.
- Inverse probability of treatment weighting (IPTW) and multivariable models were used to control for confounding factors.
Main Results:
- Statin use was not associated with a significant difference in baseline cIMT or cIMT progression over 3.2 years.
- Average cIMT progression was similar between statin users (0.062 mm/yr) and non-users (0.058 mm/yr).
- All-cause mortality was not significantly different between statin users and non-users (adjusted HR = 0.74).
Conclusions:
- In HIV-infected adults at elevated ASCVD risk, statin treatment did not reduce carotid atherosclerosis progression.
- Statin therapy was not associated with a significant reduction in total mortality in this cohort.
- Further research is warranted to elucidate the role of statins in cardiovascular risk management for HIV-infected individuals.
Background:
While HIV infection is associated with increased cardiovascular risk, benefit from statin is not well established in HIV-infected adults. We assessed whether statins are associated with a decrease in carotid artery intima-media thickness (cIMT) progression and all-cause mortality in HIV-infected adults who are at elevated ASCVD risk and recommended for statins.
Methods:
Carotid IMT was measured at baseline and follow-up in 127 HIV-infected adults who meet ACC/AHA criteria to be on statins. Inverse probability of treatment weighting (IPTW) was used to address selection bias. Multivariable models were used to control for baseline characteristics.
Results:
28 subjects (22%) were on statins and 99 subjects (78%) were not. Mean cIMT at baseline was 1.2 mm (SD = 0.34) in statin users and 1.1 mm (SD = 0.34) in non-users, and the multivariable adjusted difference was 0.05mm (95%CI -0.11, 0.21 p = 0.53). After 3.2 years of follow-up, average cIMT progression was similar in statin users and non-users (0.062mm/yr vs. 0.058 mm/yr) and the multivariable adjusted difference over the study period was 0.004 mm/yr (95% CI -0.018, 0.025, p = 0.74). All-cause mortality appeared higher in non-statin users compared with statin users, but the difference was not significant (adjusted HR = 0.74, 95%CI 0.17-3.29, p = 0.70).
Conclusion:
In a HIV cohort who had elevated ASCVD risk and meet ACC/AHA criteria for statins, treatment with statins was not associated with a reduction in carotid atherosclerosis progression or total mortality. Future studies are needed to further explore the impact of statins on cardiovascular risk in the HIV-infected population.
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