Current Calculator Underestimates Cardiovascular Event Risks in People with HIV

According to a new federally funded study by NIH, a standard risk calculator is underestimating the risk of cardiovascular disease (CVD) among people with HIV in several groups, including black people and cisgender women.

This is new data is being released at this week’s ongoing Conference on Retroviruses and Opportunistic Infections (CROI) in Denver, CO.

Investigators found that the rate of cardiovascular events occurring in many groups of people differed from predicted rates, even considering that people with HIV have a higher overall risk of cardiovascular disease than people without HIV (PWH). In high-income regions of the world, including North and South America and Europe, cardiovascular event rates were higher overall, with cisgender women experiencing about 2 and 1/2 times more events than predicted, and Black participants having more than 50% higher event rates than predicted.

The results are part of the REPRIEVE trial which enrolled 7769 people with HIV who between the ages 40 to 75 years, and was conducted in 5 continents. This is the largest trial to looking at primary prevention of major cardiovascular events in PWH.

One of the novel aspects of this trial was that the participant group was diverse regarding race and gender. And the participants were assessed to be at a low-to-moderate risk of cardiovascular disease using Pooled Cohort Risk Equations (PCE) scores. The primary analysis of this trial, published in 2023, showed that people with HIV who took pitavastatin calcium had a 35% lower risk of major adverse cardiovascular events than those taking a placebo.

These results led to the February 2024 release of recommendations for the use of statin therapy in people with HIV in the HHS clinical practice guidelines. As demonstrated by these new analyses, data from the trial continue to address knowledge gaps about cardiovascular health in people with HIV.

A second, related analysis defined risk factors contributing to the occurrence of major cardiovascular events, including heart attacks and strokes. Using an analysis that considers many varying factors, the investigators assessed risks contributing to these events. They found that the risk of experiencing a first major adverse cardiovascular event was higher for people with HIV from high-income regions; older than 50 years; Black; current or former cigarette smokers; with hypertension or a family history of early cardiovascular disease onset; or with a detectable HIV viral load, the amount of HIV in the blood.

Study Takeaways

The results of these 2 analyses reveal that while all people with HIV are at an elevated risk of cardiovascular events, the cardiovascular risk for some people may be underestimated by the current standard tools used to measure risk. The investigators noted that both traditional and HIV-related risk factors are associated with increased risk of cardiovascular disease among people with HIV. They suggested that updated tools are needed to facilitate precision, high-quality care of the diverse population living with HIV. Importantly, these studies underscore the necessity for representative inclusion in clinical trials.

Reference
Tools underestimate cardiovascular event risk in people with HIV. NIH press release. March 4, 2024. Access March 5, 2024.
https://www.nih.gov/news-events/news-releases/tools-underestimate-cardiovascular-event-risk-people-hiv