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Effects of Pitavastatin on Coronary Artery Disease and Inflammatory Biomarkers in HIV: Mechanistic Substudy of the
Michael T Lu1, Heather Ribaudo2, Borek Foldyna1
1Cardiovascular Imaging Research Center, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston.
Pitavastatin significantly reduced noncalcified coronary plaque volume and progression in people with HIV (PWH). This statin therapy also improved lipid oxidation and inflammation markers, potentially explaining its cardiovascular benefits.
Area of Science:
- Cardiology
- HIV Medicine
- Pharmacology
Background:
- People with HIV (PWH) have an increased risk of cardiovascular disease (CVD), often presenting with premature noncalcified coronary plaque.
- The REPRIEVE trial demonstrated that pitavastatin reduced major adverse cardiovascular events (MACE) by 35% in PWH.
- Understanding the mechanisms behind pitavastatin's protective effects on coronary plaque is crucial for CVD prevention strategies in PWH.
Purpose of the Study:
- To evaluate the impact of pitavastatin on noncalcified coronary artery plaque volume and progression using coronary computed tomography angiography (CTA).
- To assess the effects of pitavastatin on inflammatory biomarkers as potential mediators of MACE reduction.
- To investigate the role of pitavastatin in modifying subclinical atherosclerosis in people with HIV.
Main Methods:
- A double-blind, placebo-controlled randomized clinical trial (REPRIEVE) involving PWH without known CVD and low to moderate 10-year CVD risk.
- Participants received either oral pitavastatin (4 mg/day) or a placebo for 24 months.
- Coronary CTA and inflammatory biomarkers were measured at baseline and 24 months to assess changes in noncalcified plaque volume and progression.
Main Results:
- Pitavastatin led to a significant reduction in mean noncalcified coronary plaque volume compared to placebo (difference of -4.3 mm³; P=.04).
- Progression of noncalcified plaque was 33% less likely in the pitavastatin group (RR, 0.67; P=.003).
- Pitavastatin significantly decreased LDL cholesterol, oxidized LDL, and lipoprotein-associated phospholipase A2 levels compared to placebo.
Conclusions:
- Twenty-four months of pitavastatin therapy effectively reduced noncalcified plaque volume and progression in PWH at low to moderate CVD risk.
- Pitavastatin also improved key markers of lipid oxidation and arterial inflammation.
- These vascular and inflammatory changes likely contribute to the observed reduction in MACE in the REPRIEVE trial.
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