Customize Consent Preferences

We use cookies to help you navigate efficiently and perform certain functions. You will find detailed information about all cookies under each consent category below.

The cookies that are categorized as "Necessary" are stored on your browser as they are essential for enabling the basic functionalities of the site. ... 

Always Active

Necessary cookies are required to enable the basic features of this site, such as providing secure log-in or adjusting your consent preferences. These cookies do not store any personally identifiable data.

No cookies to display.

Functional cookies help perform certain functionalities like sharing the content of the website on social media platforms, collecting feedback, and other third-party features.

No cookies to display.

Analytical cookies are used to understand how visitors interact with the website. These cookies help provide information on metrics such as the number of visitors, bounce rate, traffic source, etc.

No cookies to display.

Performance cookies are used to understand and analyze the key performance indexes of the website which helps in delivering a better user experience for the visitors.

No cookies to display.

Advertisement cookies are used to provide visitors with customized advertisements based on the pages you visited previously and to analyze the effectiveness of the ad campaigns.

No cookies to display.


Home > Cardiology > AHA 2023 > Future of Lipid-Lowering Therapies > REPRIEVE: Mechanisms behind MACE reduction in HIV population on pitavastatin

REPRIEVE: Mechanisms behind MACE reduction in HIV population on pitavastatin

Presented by
Dr Michael Lu, Massachusetts General Hospital, USA
Conference
AHA 2023
Trial
Phase 3, REPRIEVE
Doi
https://doi.org/10.55788/978444f2
    A mechanistic substudy of the REPRIEVE trial, investigating the effects of pitavastatin on coronary artery disease (CAD) in patients with HIV, showed a risk reduction in non-calcified plaque volume, a decreased risk of plaque progression, and less evidence of lipid oxidation and arterial inflammation in patients on pitavastatin. According to the investigators, these effects could explain the reduction in major cardiovascular events (MACE) that was observed in the parent trial.

    “We know that patients with HIV have an increased risk of cardiovascular disease,” stated Dr Michael Lu (Massachusetts General Hospital, MA, USA) [1]. “Also, the moderate-intensity statin pitavastatin has minimal interaction with the antiretroviral therapy that is used by patients with HIV.” The phase 3 REPRIEVE trial (NCT02344290) randomised 7,769 participants with HIV on antiretroviral therapy with a low-to-moderate 10-year atherosclerotic cardiovascular disease (ASCVD) risk to pitavastatin calcium or placebo [2]. The primary analysis at 5.1 years showed a reduction of 35% in MACE in participants on pitavastatin compared with those who were treated with a placebo. The current analysis, presented by Dr Lu, evaluated the effect of pitavastatin on non-calcified coronary plaque formation and inflammatory and immune biomarkers in 804 participants.

    At 24 months, the authors observed a reduction of 7% in non-calcified coronary plaque volume in participants on pitavastatin compared with those on placebo (95% CI -8.6 to -0.1; P=0.044). In participants with plaques at baseline, the corresponding difference was 12%. Furthermore, the risk of non-calcified plaque progression was 33% lower in the pitavastatin group than in the placebo group (95% CI 0.52–0.88; P=0.003).

    “We also noted significant reductions in Lp-PLA2 and oxidised LDL levels in pitavastatin-treated individuals compared with placebo-treated individuals,” added Dr Lu. Changes in other biomarkers, such as MCP-1, sCD14, and IL-6, did not significantly differ between the 2 study groups at 24 months. “The results of REPRIEVE are in a similar ballpark with respect to plaque changes as other trials investigating LDL-reducing agents in higher-risk populations,” according to Dr Lu.

    In conclusion, in a primary prevention population of patients with HIV and a low-to-moderate ASCVD risk, 2 years of pitavastatin treatment was associated with reduced non-calcified plaque volumes, a lower risk of plaque progression, and a reduction in relevant biomarkers of lipid oxidation and arterial inflammation, potentially explaining the reduction in MACE that was reported in the primary analysis of this trial.


      1. Lu MT, et al. Effects of pitavastatin on coronary artery disease and inflammatory biomarkers: mechanistic substudy of the REPRIEVE primary prevention trial in HIV. LB06, AHA Scientific Sessions 2023, 11–13 November, Philadelphia, USA.
      2. Grinspoon SK, et al. N Engl J Med 2023;389:687–699.

    Copyright ©2024 Medicom Medical Publishers



    Posted on