Cardiovascular disease, or heart disease, is the leading cause of death globally, including for all people living with HIV. Now that we’re living longer due to effective antiretroviral medication, the persistent inflammation that we live with and impact of HIV means we have up to two times the risk for cardiovascular disease compared to people without HIV. We also know those of us living with HIV experience an increased risk of build up of plaques in our arteries sooner compared to people who don’t have HIV.
The outcomes of the REPRIEVE study offers a critical step to address the issue of heart disease for people living with HIV and may be one of the most significant research outcomes in 2023.
REPRIEVE was a large global randomised trial which investigated the use of statin therapy to prevent major adverse cardiovascular events (heart attack or stroke) in people living with HIV. Statins are a class of medication that are prescribed to help lower total cholesterol and reduce the risk of a heart attack or stroke. In 2015, 7,769 people living with HIV with a low-to-moderate risk of cardiovascular disease from 12 countries were enrolled in the study. The hypothesis was that the effect of a statin’s anti-inflammatory properties and lipid-lowering effect would reduce the occurrence of heart attack or stroke for the participants.
The REPRIEVE results showed the simple use of a daily statin, substantially reduces the incidence of a major adverse cardiovascular event for people living with HIV.
As reported in the New England Journal of Medicine in August 2023, the trial was stopped after early analysis showed a 35% lower incidence of heart attack or stroke among participants who received the statin compared to participants who only received a placebo. The benefit of a daily statin was clear in almost all participant subgroups across gender, race, ethnicity, CD4 count and geographical area.
The study was conducted using 4mg of Pitavastatin (Livalo, Zypitamag), which is currently unavailable in Australia. This availability may change as it goes off patent sometime in 2024. Pitavestatin was chosen for the study because it tends to be well tolerated and doesn’t interact with HIV antiretrovirals. However, there are a variety of similar statins available on prescription in Australia for people living with HIV.
In the light of this research, having a discussion with your HIV specialist about the REPRIEVE study is an important conversation for all people living with HIV to have as soon as possible. It’s a good idea to explore the benefits of a statin with your doctor, as well as any potential side effects, along with your diet and lifestyle options to reduce your risk of heart attack or stroke.
Along with starting a statin, it’s recommended that you include some or all of the following diet and lifestyle changes to support your heart health. Lifestyle changes include stopping or reducing smoking; aiming to be physically active for at least 30 minutes most days; and losing weight if you need to or maintaining a healthy weight. Diet options include reducing or limiting the saturated and trans fats that are mostly found in processed meats, butter, full-fat dairy products and deep fried foods; reducing or limiting salt and alcohol; as well as ensuring you eat a healthy balanced diet that includes plenty of fruits, vegetables, wholegrain cereals, lean meat, fish, eggs, nuts and seeds, legumes and beans, and low-fat dairy products.
If you need support to start this conversation with your doctor, you can call Positive Life on (02) 8357 8386, 1800 245 677 (freecall in NSW) or email contact@positivelife.org.au
