Myocardial Infarction, Stroke and Mortality in cART treated HIV patients on statins.
modern combination antiretroviral therapy (cART), people living with HIV (PLWH) have
persistently increased systemic inflammation compared to the general population and are
also at a higher risk for metabolic disturbances. The effects of inflammation and
metabolic disturbances, known risk factors for atherosclerosis and organ dysfunction,
may be ameliorated by statin therapy. ... read moreWe carried out a secondary analysis of prospective
cohort data to determine the association between statins and myocardial infarction (MI),
stroke and all-cause mortality in PLWH. We included 438 out of 881 HIV infected patients
from the Nutrition For Healthy Living (NFHL) cohort. We included cART treated
individuals, who were followed between September, 2000 and the present. We used Cox
proportional hazards analysis to evaluate the association between statins and the
incidence of MI, stroke and all-cause mortality as a composite outcome, where statin
exposure was examined both dichotomously and by duration of exposure. For confounding
control, we used propensity scoring for statin use in our sensitivity analyses. The
average age of our study sample (n=438) was 44 years and 32% were women. 67 (15%) of the
438 analyzed subjects used statins during follow up. We ran 2 separate models with only
one of our statin variables at the time (history or duration). There was no association
between statin therapy and our composite endpoint in either model (1.26 (0.57-2.79) in
statin history model and 0.93 (0.65-1.32) per year in statin duration model). We found
significant associations between the composite outcome and CD4 count (HR = 0.88
(0.83-0.94) per 50 CD4 cells/mL), age (HR = 1.07 (1.03-1.1)) and smoking status (HR =
1.78 (1.04-3.19)) in both models. In our analysis, statins did not have an effect on the
incidence of MI, stroke and all-cause mortality. Larger samples are needed to further
test the effects of statins on this composite outcome, and individual endpoints in PLWH.
Traditional risk factors appear to be important predictors of these outcomes in this
Thesis (M.S.)--Tufts University, 2014.
Submitted to the Dept. of Clinical & Translational Science.
Advisors: Christine Wanke, and David Kent.
Keyword: Medicine.read less