A leading HIV organization in the UK says that everyone over 40 living with HIV would benefit from taking statins. These are the medications used to lower cholesterol.
People living with HIV are known to have a raised risk of cardiovascular disease. This can lead to heart attacks and strokes.
The British HIV Association (BHIVA) now suggests everyone over 40 with HIV should be offered statins, irrespective of whether they show a raised cholesterol level in their blood.
It’s basing its new recommendations on the large REPRIEVE study, the largest randomized trial undertaken in people living with HIV. Part of the study compared participants assigned a statin against those given a placebo. Those on statins were significantly less likely to develop major cardiovascular problems.
“We recommend that all people living with HIV aged 40 years or older should be offered a statin for primary prevention of CVD irrespective of lipid profile or estimated CVD risk,” says the report.
It highlights the FDA-approved moderate-intensity pitavastatin as the medication of choice but suggests atorvastatin as an alternative. In the UK, pitavastatin is not yet available throught the national health service due to its cost. Ezetimibe can be prescribed for people who don’t react well to statins.
BHIVA also stresses that any use of statins should be combined with a wider, holistic approach. This includes good nutrition and advice about smoking and alcohol. Cigarettes, heavy drinking and obesity remain major risk factors when it comes to heart disease. Gay men in particular are known to have higher rates of both HIV and nicotine and alcohol use.
The REPRIEVE study involved 7,769 participants. The study was terminated early when a big reduction in major cardiovascular events was noted (a 35% reduction at an average five-year follow-up). Significantly, the study only recruited people with a low-to-moderate risk of serious heart disease.
Although these recommendations are aimed at the British health service, the unequivocal results of the study are something all people living with HIV over the age of 40 might want to discuss with their healthcare provider. If they do decide to prescribe a statin, make sure they’re aware of potential drug-drug interactions.
Any statin use should be closely monitor after treatment commences.