According to the authors, these improvements may be part of the reason why there was a lower rate of major adverse cardiovascular events in the REPRIEVE study.
For people with HIV (PWH) who have a low to moderate risk of cardiovascular disease (CVD) taking pitavastatin for 2 years helped decrease the amount of plaque buildup in their arteries that isn't made of calcium, while also slowing down the growth of this plaque. Pitavastatin also reduced markers of lipid oxidation and inflammation in the arteries in these patients.
These findings were published in JAMA Cardiology as a mechanistic substudy of the REPRIEVE randomized clinical trial. According to the authors, these improvements might be part of the reason why there was a lower rate of major adverse cardiovascular events (MACE) in the REPRIEVE study.
PWH have an increased prevalence of CVD compared with individuals without HIV, and it often presents with premature noncalcified coronary plaque. In the REPRIEVE study, the use of pitavastatin led to a significant 35% reduction in MACE over a median duration of 5.1 years. With this in mind, researchers sought to examine how pitavastatin affects noncalcified coronary artery plaque using coronary computed tomography angiography (CTA) and assess its impact on inflammatory biomarkers as potential mechanisms for preventing MACE.
To do so, they conducted a double-blind, placebo-controlled randomized clinical trial at 31 clinical research sites across the US from April 2015 to February 2018. Participants included PWH who did not have diagnosed CVD, had a low to moderate 10-year risk of CVD, and were undergoing antiretroviral therapy.
Of the 804 individuals initially enrolled in the substudy, 774 had at least 1 coronary CTA that could be evaluated, and of that group, plaque changes were evaluated in 611 participants who completed both CT scans. Of these analyzed participants, 513 (84.0%) were male, with a mean (SD) age of 51 (6) years and a median (IQR) 10-year CVD risk of 4.5% (2.6-7.0). In the intervention arm, 302 PWH took 4 mg oral pitavastatin calcium per day for 24 months, while 309 took placebo for the same timeframe.
The average volume of noncalcified plaque decreased when participants took pitavastatin compared with those who took the placebo, with a mean (SD) change of –1.7 (25.2) mm3 in the treatment group vs 2.6 (27.1) mm3 in the placebo group (baseline adjusted difference, –4.3 mm3; 95% CI, –8.6 to –0.1; P = .04), representing a 7% (95% CI, 1-12) greater reduction than the placebo group.
Particularly, the researchers observed a more significant reduction in the subgroup with plaque at the study's start (–8.8 mm3; 95% CI, –17.9 to 0.4), and the progression of noncalcified plaque was 33% less likely with pitavastatin compared with placebo (relative risk, 0.67; 95% CI, 0.52-0.88; P = .003). Additionally, pitavastatin led to a decrease in mean low-density lipoprotein cholesterol (LDL-C) compared with placebo, with a mean change of –28.5 mg/dL (95% CI, –31.9 to –25.1) in the pitavastatin arm and –0.8% (95% CI, –3.8 to 2.2) in the placebo arm.
The pitavastatin group also exhibited a 29% reduction in oxidized LDL (95% CI, –32 to –26) and a 7% reduction in lipoprotein-associated phospholipase A2 (95% CI, –11 to –4) compared with the placebo group at 24 months.
Reference
Lu MT, Ribaudo H, Foldyna B, et al; REPRIEVE Trial Writing Group. Effects of pitavastatin on coronary artery disease and inflammatory biomarkers in HIV: mechanistic substudy of the REPRIEVE randomized clinical trial. JAMA Cardiol. Published online February 21, 2024. doi:10.1001/jamacardio.2023.5661
Study: Anxiety May Increase Acute Exacerbation Risk for Older Patients With COPD
May 2nd 2024Older patients with chronic obstructive pulmonary disease (COPD) and anxiety exhibited exacerbated symptoms, increased comorbidities, and frequent acute exacerbations of COPD (AECOPD), emphasizing the need for routine psychiatric screening in COPD management.
Read More
Latest Advances and Updates of Treatment in the Real World at AUA
May 1st 2024The annual meeting of the American Urological Association (AUA) not only presents the newest therapies coming out but showcases the latest in how treatments are being used in the real world, said Stephen Freedland, MD, of Cedars Sinai.
Read More
The Federal Trade Commission (FTC) issued letters to 10 companies to warn them that certain drug patents were improperly listed; the US Department of Agriculture (USDA) will begin testing ground beef for bird flu particles; rural Americans are more likely to die early from 1 of the 5 leading causes of death than those who live in urban areas.
Read More