“People with human immuno deficiency virus (HIV; PWH) face an approximately 2-fold increased risk of atherosclerotic cardiovascular disease (ASCVD) compared with individuals without HIV,” researchers wrote in Clinical Infectious Diseases. “The global Randomized Trial to Prevent Vascular Events in HIV (REPRIEVE) revealed that statin therapy reduced major adverse cardiovascular events (MACE) by 36% among PWH with low-to-moderate traditional ASCVD risk.”

Steven K. Grinspoon, MD, and colleagues characterized factors associated with MACE and subcomponents in a global cohort of people with HIV in REPRIEVE. Time to first primary MACE served as the primary outcome. Secondary outcomes included time-to-first: hard MACE (cardiovascular disease [CVD] death, myocardial infarction [MI], or stroke); MI; and stroke. The researchers used Cox proportional hazard models to estimate the hazard of baseline risk factors for each outcome.

Factors Associated With Higher MACE Risk

Among 7,769 participants, the median age was 50 years, with 31% of patients identified as assigned female sex-at-birth. Patients had a median 10-year pooled cohort equations ASCVD risk score of 4.5%.

In fully adjusted models, the risk for first MACE was higher in individuals aged 50-59 and 60 years or older compared with those aged 40-49, with HRs of 2.06 (95% CI: 1.54-2.76) and 2.53 (95% CI: 1.60-4.01), respectively. The increased risk was also observed in Black individuals versus White race in high-income countries (HR, 1.65; 95% CI, 1.19-2.27), those with a family history of premature cardiovascular disease (HR, 1.53; 95% CI, 1.16, 2.03), current smokers (HR, 2.27; 95% CI, 1.65, 3.13), individuals with hypertension (HR, 1.77; 95% CI, 1.36-2.30), and lower HDL cholesterol (HR, 1.21; 95% CI, 1.10-1.34).

Dr. Grinspoon and colleagues noted that certain HIV variables, including an HIV-1 RNA lower-limit-of-quantification (HR, 1.40; 95% CI, 1.0-1.97) and being on specific ART regimens (HR, 1.53; 95% CI, 1.01-2.31), also increased the risk for first MACE.

Patients from high-income countries had an increased risk for first MACE compared with those from other regions, except South Asia. No protective effect of female sex was noted. Modeling for hard MACE, MI, and stroke provided generally similar results for most variables.

“Our work clarifies clinical practice and public health imperatives relevant to mitigating CVD risk among [people with HIV] globally,” Dr. Grinspoon and colleagues wrote. “Specifically, our work supports an emphasis on smoking abstinence or cessation, timely diagnosis and treatment of hypertension, and early and consistent HIV treatment with [antiretroviral therapy].”