Category: Cardiovascular Disease

Categories : Cardiovascular Disease Metabolic DisordersTags :

Semaglutide Also Cuts Cardiovascular Risk, Could Change Cardiology Practice

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According to results from the SELECT trial run by Novo Nordisk, semaglutide dramatically reduces the risk of major adverse cardiovascular events (MACEs) in addition to its obesity benefits. This is bolstered by the results of another trial, STEP-1, which also suggested significant reduction in future cardiovascular events. These results have captured the attention of researchers, who commented in Nature that they could change the practice of cardiology.

Semaglutide, sold in the US for the treatment of both obesity (Wegovy) and diabetes (Ozempic), is an agonist for glucagon-like peptide 1 (GLP-1), a hormone associated with appetite.

”It’s hard to think of other [drugs], apart from statins, that have shown such a profound effect,” says Martha Gulati, director of preventive cardiology at Cedars-Sinai Medical Center in Los Angeles, USA.

It was expected that semaglutide would have cardiovascular benefits through promoting weight loss, but evidence shows that drugs mimicking GLP-1 can improve fatty-acid metabolism and reduce inflammation, for example, says Gulati. “This is what’s so fascinating about these drugs. They work on the brain, the pancreas, the cardiovascular system, the gastrointestinal tract … There’s more to them than simply weight loss.”

Recent studies have been encouraging in terms of semaglutide’s benefits for reducing cardiovascular disease risk. Earlier this month, Novo Nordisk announced the headline results from the SELECT cardiovascular outcomes trial. The double-blinded trial compared subcutaneous once-weekly semaglutide 2.4mg with placebo as an adjunct to standard of care for prevention of MACEs over a period of up to five years. The trial enrolled 17 604 adults aged 45 years or older with overweight or obesity and established cardiovascular disease (CVD) with no prior history of diabetes.

The trial showed 20% reduction in MACEs for people treated with semaglutide 2.4mg compared to placebo. The primary endpoint was a composite outcome of the first occurrence of MACE cardiovascular death, non-fatal myocardial infarction or non-fatal stroke. All three of these components contributed to the MACE reduction. 1270 first MACEs were accrued.

Expanding GLP-1 analogues to cardiovascular disease prevention may not be without challenges, as the European Medicines Agency opened investigations into semaglutide and liraglutide over reports of suicidal thoughts and self-harm.

A separate study based on the STEP 1 trial data found that 93 million adults in the US could benefit from semaglutide, from a combination of weight loss and reduced cardiovascular benefits. They estimate a reduction in relative risk of 18% with the drug.

Categories : Cardiovascular Disease Substance UseTags :

More than 1 in 10 Cardiac Patients in ICU Found to Have Recreational Drugs in Their Systems

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Recreational drug use may be a factor in a significant proportion of admissions to cardiac intensive care, with various substances detected in 1 in 10 such patients, suggest the findings of a multicentre French study published online in the journal Heart. 

Drug use was also associated with significantly poorer outcomes, with users nearly 9 times as likely to die or require emergency intervention as other heart patients while in hospital, and 12 times as likely to do so if they used more than one drug. 

Recreational drug use is a known risk factor for cardiovascular incidents, such as a heart attack or abnormal heart rhythm (atrial fibrillation), explain the researchers. An estimated 275 million people around the globe indulged in this activity in 2022, a 22% increase on the figure for 2010, they add.

But it’s not clear how common recreational drug use is among patients admitted to hospital with heart problems, or to what extent this affects the likely course of their condition.

To try and find out, the researchers analysed the urine samples of all patients admitted to cardiac intensive care in 39 French hospitals during one fortnight in April 2021, with a view to  detecting recreational drug use.

During this period, 1904 patients were admitted, 1499 of whom provided a urine sample – average age 63, 70% male. Of these, 161 (11%) tested positive for various recreational drugs, but only just over half (57%) of whom admitted to using.

Prevalence was even higher among the under-40s, 1 in 3 (33%) of whom tested positive for recreational drugs.

The most frequently detected substance was cannabis (9%), followed by opioids (2%), cocaine (just under 2%), amphetamines (nearly 1%), and MDMA or ecstasy (just over 0.5%). 

Compared with other non-using heart patients, users were more likely to die or to require emergency intervention for events such as cardiac arrest or acute circulatory failure (haemodynamic shock) while in hospital: 3% vs 13% – especially if they had been admitted for heart failure or a particular type of heart attack (STEMI).

After adjusting for other underlying conditions, such as HIV, diabetes, and high blood pressure, users were nearly 9 times as likely to die or require emergency treatment. 

While cannabis, cocaine, and ecstasy were each independently associated with these incidents, and single drug use was detected in nearly 3 out of 4 patients (72%), several drugs were detected in more than 1 in 4 (28%) users: these patients were at even greater risk, being 12 times as likely to die or require emergency treatment. 

This is an observational study, so can’t establish that recreational drug use resulted in admission to cardiac intensive care. The researchers also acknowledge that the study was only conducted over 1 fortnight in April, so the findings might not be applicable to other months of the year or the longer term.

And they caution: “Although the strong association between the use of recreational drugs and the occurrence of [major adverse events] suggests an important prognostic role, the limited number of events requires caution in the clinical interpretation of these findings.”

But recreational drugs can increase blood pressure, heart rate, temperature, and consequently the heart’s need for oxygen, they explain. 

And they conclude: “While the current guidelines recommend only a declarative survey to investigate recreational drug use, these findings suggest the potential value of urine screening in selected patients with acute cardiovascular events to improve risk stratification in [cardiac intensive care].” 

In a linked editorial, doctors from London’s St Bartholomew’s Hospital and Queen Mary’s University of London reiterate that the study wasn’t designed to uncover a causal relationship. Larger studies would be needed to try and establish that.

But the study findings prompt two obvious questions, they suggest: “(1) Should patients admitted to intensive cardiac care units be screened for recreational drug use: and (2) What, if any, interventions might be implemented following a positive patient test result?”

Knowing that a patient had used recreational drugs might shed light on the cause of their condition and inform how it’s managed, they suggest. It might have other benefits too.

“A positive test result would provide an opportunity for counselling about the adverse medical, psychological, and social effects of drugs, and for the implementation of interventions aimed at the cessation of drug use,” they write.

But quite apart from the cost, screening raises issues of patient confidentiality and the potential for discrimination in how targeted screening might be applied, they say.

And they conclude: “There is a considerable way to go, however, before screening for recreational drug use can be recommended.”

Source: The BMJ

Categories : Cardiovascular DiseaseTags :

Why Blood Vessel Linings go Wrong and Contribute to Plaque Growth

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University of Virginia Health researchers probing the causes of coronary artery disease have identified why blood vessel lining, which usually secure plaques to stop them drifting, sometimes instead contribute to plaque buildup. The discovery, published in Circulation: Genomic and Precision Medicine, provides new targets for scientists looking for better ways to treat and prevent the disease.

“Smooth muscle cells that make up the bulk of our blood vessels play important roles in coronary artery disease. They undergo pathological transformations as the disease develops inside our arteries,” said researcher Mete Civelek, of the University of Virginia School of Medicine’s Center for Public Health Genomics and the Department of Biomedical Engineering.

“Our results point to a previously underappreciated role for metabolic pathways during this pathological transformation,” he said.

Civelek and his team wanted to unravel a longstanding mystery about the behaviour of smooth muscle cells during plaque formation. These cells, which line blood vessels, protect the body during plaque formation by building stabilising caps over the plaque that prevent the lesions from breaking loose and causing strokes.

But sometimes smooth muscle cells begin to accelerate the plaque development and spur the progression of the disease, scientists believe.

Civelek’s new discovery helps explain why. Noah Perry, a doctoral student on Civelek’s team, analysed smooth muscle cells collected from 151 heart transplant donors and used a sophisticated approach to identify genes responsible for the smooth muscle cells’ behaviour.

After initially identifying 86 groups of genes, the researchers focused in on 18 groups that could explain the mysterious behaviour. Their analysis suggested that the smooth muscle cells’ shift might stem from problems with how the cells use nitrogen and glycogen.

The researchers identified a particular sugar, mannose, that may be contributing to the problems, potentially even triggering them. But determining that, the scientists say, will require more research.

“The metabolic shift in the cells as they transition to a disease state can point to points of intervention and therapy,” said Perry, of UVA’s Department of Biomedical Engineering, the lead author of the study.

By better understanding what triggers the smooth muscle cells to become harmful, Civelek says, doctors may be able to develop ways to prevent that from happening. That could open the door to new ways to treat and prevent coronary artery disease.

“Coronary artery disease is still the leading cause of death worldwide,” Civelek said. “Although cholesterol-lowering therapies and blood pressure control have been very effective tools to prevent deaths from heart attacks, we still need more targets to reduce the suffering of patients and their families from this devastating disease.”

Source: University of Virginia

Categories : Cardiovascular Disease ExerciseTags :

Health Benefits Appear Even with Fewer Steps per Day

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Contrary to previous belief, fewer numbers of daily steps are necessary for health benefits to appear, according to the largest analysis to investigate this. The study, published in the European Journal of Preventive Cardiology, found that walking at least 3967 steps a day started to reduce the risk of dying from any cause, and 2337 steps a day reduced the risk of dying from cardiovascular disease.

The new analysis included 226 889 people from 17 different studies around the world. It showed that the risk of dying from any cause or from cardiovascular disease decreases significantly with every 500 to 1000 extra steps you walk. An increase of 1000 steps a day was associated with a 15% reduction in the risk of dying from any cause, and an increase of 500 steps a day was associated with a 7% reduction in dying from cardiovascular disease.

The researchers, led by Maciej Banach, Professor of Cardiology at the Medical University of Lodz, Poland, and Adjunct Professor at the Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, found that even if people walked as many as 20 000 steps a day, the health benefits continued to increase, with no upper limit found yet.

“Our study confirms that the more you walk, the better,” says Prof Banach. “We found that this applied to both men and women, irrespective of age, and irrespective of whether you live in a temperate, sub-tropical or sub-polar region of the world, or a region with a mixture of climates. In addition, our analysis indicates that as little as 4000 steps a day are needed to significantly reduce deaths from any cause, and even fewer to reduce deaths from cardiovascular disease.”

According to World Health Organization data, insufficient physical activity is the fourth most frequent cause of death in the world, with 3.2 million deaths a year related to physical inactivity. The COVID-19 pandemic also resulted in a reduction in physical activity, and activity levels have not recovered two years on from it.

Dr Ibadete Bytyçi from the University Clinical Centre of Kosovo, Pristina, Kosovo, senior author of the paper, says: “Until now, it’s not been clear what is the optimal number of steps, both in terms of the cut-off points over which we can start to see health benefits, and the upper limit, if any, and the role this plays in people’s health. However, I should emphasise that there were limited data available on step counts up to 20 000 a day, and so these results need to be confirmed in larger groups of people.”

This meta-analysis is the first not only to assess the effect of walking up to 20 000 steps a day, but also to look at whether there are any differences depending on age, sex or where in the world people live.

The studies analysed by the researchers followed up participants for a median (average) of seven years. The mean (average) age was 64, and 49% of participants were female.

In people aged 60 years or older, the size of the reduction in risk of death was smaller than that seen in people aged younger than 60 years. In the older adults, there was a 42% reduction in risk seen in those who walked 6000–10 000 steps a day, while there was a 49% reduction in risk in younger adults who walked 7000–13 000 steps a day.

Prof Banach says: “In a world where we have more and more advanced drugs to target specific conditions such as cardiovascular disease, I believe we should always emphasise that lifestyle changes, including diet and exercise, which was a main hero of our analysis, might be at least as, or even more effective in reducing cardiovascular risk and prolonging lives. We still need good studies to investigate whether these benefits may exist for intensive types of exertion, such as marathon running and iron man challenges, and in different populations of different ages, and with different associated health problems. However, it seems that, as with pharmacological treatments, we should always think about personalising lifestyle changes.”

Strengths of the meta-analysis include its size and that it was not restricted to looking at studies limited to a maximum of 16 000 steps a day. Limitations include the observational nature of the study. The impact of step counts was not tested on people with different diseases; all the participants were generally healthy when they entered the studies analysed. The researchers were not able to account for differences in race and socioeconomic status, and the methods for counting steps were not identical in all the studies included in this meta-analysis.

Source: European Society of Cardiology

Categories : Cardiovascular Disease Lab Tests and ImagingTags :

MRI Scan Combination Could Detect Hypertrophic Cardiomyopathy Early

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Combining two types of heart scan techniques could help detect hypertrophic cardiomyopathy (HCM) before symptoms and signs on conventional tests appear, according to a new study led by UCL researchers. To do this, they used two cutting-edge heart scanning techniques: cardiac diffusion tensor imaging (cDTI), which shows the heart’s microstructure and cardiac MRI perfusion (perfusion CMR), which reveals microvascular disease. Their findings, published in Circulation, will help doctors select appropriate treatments.

HCM is a disease which affects around 1 in 500 in the UK, causing thickening of heart muscle and can lead to heart failure and cardiac arrest.

Researchers studied the hearts of three groups: healthy people, people who already had HCM, and people with an HCM-causing genetic mutation but no overt signs of disease.

The scans showed that people with overt signs of HCM have very abnormal organisation of their heart muscle cells and a high rate and severity of microvascular disease compared to healthy volunteers, helping doctors more accurately spot the early signs of HCM.

Crucially, the scans were also able to identify abnormal microstructure and microvascular disease in the people who had a problematic gene but no symptoms or muscle thickening. They found that 28% had defects in their blood supply, compared to healthy volunteers. This meant that doctors were able to more accurately spot the early signs of HCM developing in patient’s hearts.

The first drug to slow HCM progression, mavacamten, has recently been approved for use in Europe and will allow doctors to reduce the severity of the disease once symptoms and muscle thickening have appeared. Genetic therapies are also in development which could prevent symptoms entirely by intercepting HCM development at an early stage.

Perfusion CMR is already being used in some clinics to help differentiate people with HCM from other causes of muscle thickening. The researchers think that these revolutionary new therapies, combined with cDTI and perfusion CMR scans, give doctors the best ever chance of treating people at risk of HCM early enough that the condition never develops.

Dr George Joy, who led the research with Professor James Moon and Dr Luis Lopes (all UCL Institute of Cardiovascular Science), said: “The ability to detect early signs of HCM could be crucial in trials testing treatments aimed at preventing early disease from progressing or correcting genetic mutations. The scans could also enable treatment to start earlier than we previously thought possible.

“We now want to see if we can use the scans to identify which patients without symptoms or heart muscle thickening are most at risk of developing severe HCM and its life-changing complications. The information provided from scans could therefore help doctors make better decisions on how best to care for each patient.”

Dr Luis Lopes (UCL Institute of Cardiovascular Science), senior author of the study, said: “By linking advanced imaging to our cohort of HCM patients (and relatives) with extensive genetic testing, this study detected microstructural abnormalities in vivo in mutation carriers for the first time and was the first to compare these parameters in HCM patients with and without a causal mutation.

“The findings allow us to understand more about the early subclinical manifestations of this serious condition but also provide additional clinical tools for screening, monitoring and hopefully in the near future for therapeutic decision-making.”

Source: University College London

Categories : Cardiovascular Disease ExerciseTags :

Review Identifies Most Effective Forms of Exercise to Reduce Blood Pressure

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A meta-analysis published in the British Journal of Sports Medicine has shown that isometric exercises, which involve contracting muscles to hold the body in position without moving such as in wall squats, are best for reducing resting blood pressure. The researchers reviewed 270 randomised clinical trials with a total of 15 827 participants.

All of the studies included measured blood pressure after two weeks or more of exercise intervention, and included non-intervention control groups. It was found that isometric exercises reduced systolic and diastolic blood pressure by 8.24 and 4.00mmHg respectively. The next most effective forms of training in reducing blood pressure were combined training, followed by dynamic resistance training, aerobic exercise, and high-intensity interval training (HIIT).

The researchers noted that current guidelines are based on older research and as such don’t include data from new forms of exercise such as HIIT. These guidelines tend to emphasise aerobic training such as running for controlling blood pressure. In addition to helping clinicians optimise individualised exercise recommendations, the new findings suggest that it might be time to update exercise guidelines for preventing and treating high blood pressure.

Source: JAMA Network

Categories : Cardiovascular DiseaseTags :

Regular Alcohol Drinking may Raise Blood Pressure Even in Non-Hypertensive Adults

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An analysis of seven international research studies found that, even in adults without hypertension, blood pressure (BP) readings may climb more steeply over the years as the number of daily alcoholic drinks rise. The findings, published in the journal Hypertension, also found no beneficial effects to a low level of alcohol intake.

Pooling seven international research studies, this analysis confirms for the first time a continuous increase in blood pressure measures in both participants with low and high alcohol intake. Even low levels of alcohol consumption were associated with detectable increases in blood pressure levels that may lead to a higher risk of cardiovascular events.

“We found no beneficial effects in adults who drank a low level of alcohol compared to those who did not drink alcohol,” said senior study author Marco Vinceti, MD, PhD, a professor of epidemiology and public health at the University of Modena and Reggio Emilia University and an adjunct professor at Boston University’s School of Public Health. “We were somewhat surprised to see that consuming an already-low level of alcohol was also linked to higher blood pressure changes over time compared to no consumption – although far less than the blood pressure increase seen in heavy drinkers.”

“Our analysis was based on grams of alcohol consumed and not just on the number of drinks to avoid the bias that might arise from the different amount of alcohol contained in ‘standard drinks’ across countries and/or types of beverages,” said study co-author Tommaso Filippini, MD, PhD, an associate professor of epidemiology and public health in the Medical School of the University of Modena and Reggio Emilia in Italy, and affiliate researcher at the University of California Berkeley School of Public Health.

Researchers reviewed the health data for all participants across the seven studies for more than five years. They compared adults who drank alcohol regularly with non-drinkers and found:

  • Systolic BP rose 1.25mmHg in people who consumed an average of 12 grams of alcohol per day, rising to 4.9mmHg in people consuming an average of 48 grams of alcohol per day.
  • Diastolic BP rose 1.14mmHg in people consuming an average of 12 grams of alcohol per day, rising to 3.1mmHg in people consuming an average of 48 grams of alcohol per day. These associations were seen in males but not in females. Diastolic blood pressure measures the force against artery walls between heartbeats and is not as strong a predictor of heart disease risk in comparison to systolic.

“Alcohol is certainly not the sole driver of increases in blood pressure; however, our findings confirm it contributes in a meaningful way. Limiting alcohol intake is advised, and avoiding it is even better,” Vinceti said.

Although none of the participants had high blood pressure when they enrolled in the studies, their blood pressure measurements at the beginning did have an impact on the alcohol findings.

”We found participants with higher starting blood pressure readings, had a stronger link between alcohol intake and blood pressure changes over time. This suggests that people with a trend towards increased (although still not ‘high’) blood pressure may benefit the most from low to no alcohol consumption,” said study co-author Paul K. Whelton, MD, MSc, at Tulane University’s School of Public Health.

Study details and background:

  • Researchers analysed data from seven, large, observational studies involving 19 548 adults (65% men), ranging in age from 20 to their early 70s at the start of the studies.
  • The studies were conducted in the United States, Korea and Japan, and published between 1997 and 2021. None of the participants had previously been diagnosed with high blood pressure or other cardiovascular diseases, diabetes, liver disease, alcoholism or binge drinking.
  • Usual alcoholic beverage intake was recorded at the beginning of each study and the researchers translated this information into a usual number of grams of alcohol consumed daily. The researchers used a new statistical technique that allowed them to combine results from several studies and plot a curve showing the impact of any amount of alcohol typically consumed on changes in blood pressure over time.

Other co-authors and authors’ disclosures are listed in the manuscript.

Source: American Heart Association

Categories : Cardiovascular Disease Metabolic DisordersTags :

SGLT-2 Inhibitors Reduce HF Hospitalisation Risk in Type 2 Diabetes

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A study published in Annals of Internal Medicine has suggested that the new sodium-glucose co-transporter 2 inhibitors (SGLT-2i) may be viable as a first-line treatment in patients with type 2 diabetes (T2D), with reduced odds of hospitalisation for heart failure compared to those receiving metformin.

In cardiovascular outcome trials among adults with T2D, SGLT-2i have shown therapeutic promise, including reduced risk of hospitalisation for heart failure compared to placebo. However, SGLT-2i have mainly been evaluated as a second-line treatment, as metformin is generally given as a first-line, antidiabetic treatment.

In a new study, researchers from the Brigham compared cardiovascular outcomes among adults with T2D who initiated first-line treatment with either metformin or SGLT-2i. For the study, 8613 patients treated with SGLT-2i were matched to 17 226 patients treated with metformin. The authors found that patients receiving SGLT-2i showed a similar risk for myocardial infarction, stroke, and all-cause mortality, and a lower risk for hospitalization for heart failure compared with patients who received metformin. The risk for adverse events was similar except for an increased risk for genital infections compared with those receiving metformin.

“Our results suggest that SGLT-2i may be considered as first-line treatment for patients with T2D and cardiovascular disease or who are at increased risk for cardiovascular events,” said lead author HoJin Shin, BPharm, PhD, of the Division of Pharmacoepidemiology and Pharmacoeconomics. “However, more evidence from randomised clinical trials or observational studies will help us to identify patients who would benefit most from using SGLT-2i as first-line type 2 diabetes treatment.”

Source: EurekAlert!

Categories : Ageing Cardiovascular DiseaseTags :

Rethink Preventative Aspirin for Older Adults, Researchers Say

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Low-dose aspirin is used as primary prevention for ischaemic stroke, but its protective effect weighed against the increased risk of bleeding events is controversial. A new secondary analysis of daily aspirin in older people found that, in this population, aspirin failed to reduce the risk for ischaemic stroke but increased it for intracranial bleeding. The findings were presented in JAMA Network Open.

The researchers analysed data from the ASPREE randomised clinical trial, the first large-scale trial to study the risks and benefits of 100mg daily aspirin in an older population, where increased bleeding risk may alter the balance of risks and benefits of aspirin. This is particularly relevant to intracerebral events because intracranial haemorrhage is harder to treat than ischaemic events and more frequently fatal or disabling. With previous aspirin trials in mostly younger participants, excess intracerebral haemorrhagic events was seen, though usually few in number and non-significant.

Cloud et al. performed a secondary analysis of the ASPREE trial, which included 19 114 older adults, and found a statistically significant 38% increase in intracranial bleeding resulting from a combination of haemorrhagic stroke and other causes of intracerebral haemorrhage among individuals randomised to aspirin. The difference in incidence of ischaemic stroke was not statistically significant.

While aspirin did not cause a statistically significant reduction in ischaemic stroke (hazard ratio [HR], 0.89), there was a a statistically significant 38% increase in intracranial bleeding. Rates of intracranial bleeding from those assigned to aspirin (1.1%) were higher than placebo (0.8%). This came from an increase in a combination of subdural, extradural, and subarachnoid bleeding with aspirin (0.6%) compared with placebo (0.4%). Haemorrhagic stroke was recorded in 0.5% of those assigned to aspirin compared with 0.4% for placebo.

Absolute numbers of haemorrhagic and non-haemorrhagic events were small. Among 1000 individuals taking 100mg/day of low-dose aspirin over five years, there were 2.5 fewer ischaemic strokes at the expense of 3.5 cases of intracranial haemorrhage, but not statistically significant. No difference would be expected for overall stroke incidence or stroke mortality, but haemorrhagic stroke was associated with a mortality rate of nearly a third, compared to 7.7% for ischaemic stroke. Major extracranial haemorrhage was driven by the increased risk of upper gastrointestinal bleeding with aspirin compared with placebo, as previously found (Hazard Ratio, 1.87).

The researchers concluded that “there was no statistically significant benefit from aspirin in preventing stroke or any conventional stroke etiological subtype. However, aspirin significantly increased the overall risk of intracranial bleeding.”

Categories : Cardiovascular Disease HIVTags :

Daily Statin Reduces Risk of Major Cardiovascular Events in People Living with HIV

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A new study published in the New England Journal of Medicine found that statins, a class of cholesterol-lowering medications, may offset the high risk of cardiovascular disease in people living with HIV by more than a third, potentially preventing one in five major cardiovascular events or premature deaths in this population. People living with HIV can have a 50–100% increased risk for cardiovascular disease.

“This research suggests that statins may provide an accessible, cost-effective measure to improve the cardiovascular health and quality of life for people living with HIV,” said Gary H. Gibbons, MD, director of the National Heart, Lung, and Blood Institute (NHLBI), a study funder. “Additional research can further expand on this effect, while providing a roadmap to rapidly translate research findings into clinical practice.”

For the double-blinded phase 3 trial, known as Randomised Trial to Prevent Vascular Events in HIV (REPRIEVE) study, researchers randomised participants into either a treatment group, where they received pitavastatin calcium daily or a control group receiving placebo. The researchers followed participants for about five years, but ended the trial early when they discovered the treatment benefits outweighed potential risks.

To understand the benefits, the researchers compared how often participants in each group experienced major cardiovascular events, including heart attacks, strokes, or surgery to open a blocked artery. They found participants who took daily pitavastatin had 35% fewer major cardiovascular events than those who took a placebo. The researchers also measured the number of deaths in combination with major cardiovascular events during the study period and found participants in the treatment group were 21% less likely than those in the placebo group to experience these events. Additionally, those taking pitavastatin had a 30% reduction in their low-density lipoprotein (LDL) cholesterol levels.

“Lowering LDL cholesterol levels reduces risks for cardiovascular events, like having a heart attack and stroke, but these findings suggest there may be additional effects of statin therapy that explain these reduced risks among people living with HIV,” said Steven K. Grinspoon, MD, the study chair. “Ongoing research about how statin therapy may affect inflammation and increased immune activation among people with HIV may help us better understand the additional benefits we’re seeing with this treatment approach.” 

To support optimal health outcomes among the study participants, normal liver and kidney function were an enrolment criteria. They were also required to take antiretroviral therapy, which itself is critical to reducing the risk of HIV complications and related comorbidities, including cardiovascular disease.

Beginning in 2015, REPRIEVE enrolled 7769 adults, ages 40–75, from 145 sites in 12 countries. Adults in the study were an average age of 50 and had low-to-moderate risks for cardiovascular disease, which meant they normally would not have been prescribed statins. Women accounted for 31% of participants. Approximately 41% of study participants identified as Black, 35% as white, 15% as Asian, and 9% as another race.

Source: National Insitutes of Health