Statins for primary prevention of cardiovascular disease in people with HIV

Compilation
GeSIDA, AIDS Study Group of the Spanish Society of Infectious Diseases and Clinical Microbiology (Seimts), published a position paper on the use Statins in primary prevention of cardiovascular diseases in people with HIVThe main recommendation based on the Reprive clinical trial is: Consider prescribing statins to people with HIV over 40 years of age with low or moderate cardiovascular risk..

The Reprive study demonstrates a reduction in cardiovascular events in primary prevention with this type of lipid-lowering drug in people who do not have high cardiovascular risk.

The Reprive study is the first large-scale clinical trial to evaluate the prevention of cardiovascular disease in people with HIV, demonstrating that use of statins for primary prevention significantly reduces cardiovascular eventseven in individuals without high risk.

Hesida’s paper highlights the importance of early offer of statin treatment to people with HIV over 40 years of age after assessing their cardiovascular risk using scores such as Ascvd or Regicor. If the risk of Ascvd below 5% in 10 yearswill be considered individualized A moderate activity statin. In case the risk of Ascvd is between 5 and 10% at 10 years old, and Moderately active statin. If the risk of Ascvd more than 10%A statins and a goal of lowering LDL cholesterol will be set. according to clinical guidelines aimed at the general population. Pitavastatin (4 mg) is the recommended moderate-potency statin, followed by alternatives such as atorvastatin (20 mg) or rosuvastatin (10 mg).

Hesida emphasizes that, in general, “the expected benefits of primary prevention of cardiovascular disease with statins outweigh the risks of side effects.”

Engaging primary health care and facilitating access

In addition, Hesida emphasizes the need to involve doctors in primary care and other experts in the prevention of cardiovascular disease in people with HIV. In addition, it emphasizes the importance of taking global approach This includes lifestyle changes and quitting smoking. One of the problems identified is cost of treatmentwhich can impact patient adherence to treatment. Hesida calls on regional health systems and the national system facilitate access to these treatmentsensuring that they do not represent an additional financial burden for patients.

The document also discusses possible interactions statins with antiretroviral treatment, recommending pitavastatin and rosuvastatin as the options with the lowest risk of interactions. Although statin treatment generally has a low risk of side effects, studies such as Reprive have seen an increase in diabetes and myopathy. However, Ghesida concludes that in general «expected benefits from Primary cardiovascular prevention with statins outweighs risks of side effects“.