Factors Affecting Risk of Cardiovascular Disease (CVD) Events in a Global CVD Prevention Cohort of People With HIV

Area of Science:

• Cardiovascular disease risk in specific populations
• HIV medicine and treatment outcomes
• Public health and epidemiology

Background:

• People with HIV (PWH) experience elevated risks of major adverse cardiovascular disease (MACE).
• Statin therapy offers partial mitigation of these cardiovascular risks.
• Understanding specific risk factors for MACE in PWH is crucial for targeted prevention.

Purpose of the Study:

• To characterize factors associated with MACE and its subcomponents in a global cohort of PWH.
• To identify modifiable risk factors contributing to cardiovascular events in the REPRIEVE study population.
• To assess the impact of various demographic, clinical, and lifestyle factors on MACE risk.

Main Methods:

• Analysis of a global cohort of 7,769 People with HIV (PWH) from the REPRIEVE study.
• Primary outcome: time-to-first primary MACE. Secondary outcomes: hard MACE, myocardial infarction (MI), stroke.
• Cox proportional hazards models were employed to estimate the hazard of baseline risk factors for MACE.

Main Results:

• Increased MACE risk observed in older individuals, Black or African American race (within HIC), family history of premature CVD, current smoking, hypertension, low HDL, detectable HIV RNA, and specific ART regimens.
• Individuals residing in high-income countries (HIC) showed a higher risk of MACE compared to other regions (except South Asia).
• Female sex was not found to be protective against MACE in this cohort.

Conclusions:

• Modifiable risk factors including cigarette smoking, hypertension, low HDL cholesterol, and detectable HIV-1 RNA are significantly associated with MACE in PWH, even when accounting for statin use.
• These findings highlight key targets for cardiovascular risk reduction strategies in the PWH population.
• Female sex did not confer a protective cardiovascular benefit in this study population.