Clinical question: Does pitavastatin reduce the risk of cardiovascular disease in human immunodeficiency virus (HIV)-infected individuals?
Background: Individuals with HIV infection have up to twice the risk of atherosclerotic cardiovascular disease compared to the general population. While statins are known to lower low-density lipoprotein cholesterol and have beneficial effects on inflammatory and immune pathways, their efficacy in primary prevention of cardiovascular events in HIV-infected patients is not well-established.
Study design: Phase 3 randomized trial
Setting: Multi-center trial across 12 countries
Synopsis: In this study of 7,769 virally suppressed HIV-infected individuals (median age 50), the efficacy of pitavastatin calcium (4 mg daily) was compared to a placebo in preventing major cardiovascular events. Over a median follow-up of 5.1 years, the pitavastatin group exhibited a reduced event rate of 4.81 per 1,000 person-years, compared to the placebo group’s 7.32. This translated to a hazard ratio of 0.65. However, the pitavastatin group reported increased muscle-related symptoms and a higher incidence of diabetes mellitus. The study’s limitations include its relatively short duration, focus on a healthier HIV cohort, and lack of comparison with other statins.
Hospitalists should note that while pitavastatin may offer cardiovascular benefits for well-controlled HIV-infected patients, it’s vital to monitor for potential muscle complications and new diabetes onset.
Bottom line: Pitavastatin effectively prevents cardiovascular disease in individuals with well-controlled HIV and a low-to-moderate cardiovascular disease risk, while maintaining a favorable tolerability profile.
Citation: Grinspoon SK, et al. Pitavastatin to prevent cardiovascular disease in HIV infection. N Engl J Med. 2023;389(8):687-99.
Dr. Sheikh is the associate program director, department of internal medicine, and assistant professor, division of hospital medicine, at the University of New Mexico, Albuquerque, N.M.