Pitavastatin reduces noncalcified plaque in people with HIV at low-to-moderate CVD risk

In people living with HIV (PWH) who are at low-to-moderate risk of cardiovascular disease (CVD), use of pitavastatin for 2 years leads to a reduction in noncalcified plaque volume and progression, which potentially contributes to a decrease in major adverse cardiovascular events (MACE), according to the results of the mechanistic substudy of the REPRIEVE trial.

The analysis included 611 PWH (mean age 51 years, 84.0 percent men) without known CVD who were taking antiretroviral therapy and had low-to-moderate 10-year CVD risk (median 4.5 percent). Of these, 302 participants received oral pitavastatin calcium at 4 mg per day and 309 received placebo.

Researchers examined the effect of pitavastatin on noncalcified coronary artery plaque visualized by coronary computed tomography angiography (CTA) and on inflammatory biomarkers as potential mechanisms for MACE prevention.

Over 24 months of treatment, pitavastatin produced a 7-percent greater reduction in the mean noncalcified plaque volume compared with placebo (mean change, −1.7 vs 2.6 mm3; baseline adjusted difference, −4.3 mm3, 95 percent confidence interval [CI], −8.6 to −0.1; p=0.04).

The effect size with pitavastatin vs placebo was larger for the subgroup of participants with plaque at baseline (−8.8 mm3, 95 percent CI, −17.9 to 0.4).

Compared with the placebo group, the pitavastatin group was less like likely to experience progression of noncalcified plaque (relative risk, 0.67, 95 percent CI, 0.52–0.88; p=0.003) and had a greater decrease in oxidized low-density lipoprotein (−29 percent vs −13 percent; p<0.001) and lipoprotein-associated phospholipase A2 (−7 percent vs 14 percent; p<0.001) at 24 months.