Frailty, Pitavastatin, and Major Adverse Cardiovascular Events Among People With HIV
Background: People with HIV (PWH) are at increased risk for atherosclerotic cardiovascular diseases (ASCVDs) and geriatric syndromes, including frailty. REPRIEVE (Randomized Trial to Prevent Vascular Events in HIV) demonstrated a 36% reduction in major adverse cardiovascular events (MACE) with pitav...
Saved in:
| Main Authors: | , , , , , , , , , , , , , , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Elsevier
2025-09-01
|
| Series: | JACC: Advances |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2772963X25005022 |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| _version_ | 1849229229049249792 |
|---|---|
| author | Kristine M. Erlandson, MD, MS Ariela R. Orkaby, MD Triin Umbleja, MSc Heather J. Ribaudo, PhD Todd T. Brown, MD, PhD Markella V. Zanni, MD Marissa R. Diggs, AB Sarah M. Chu, MSN Kathleen V. Fitch, MSN Carl J. Fichtenbaum, MD Carlos Malvestutto, MD, MPH Judith A. Aberg, MD Gerald S. Bloomfield, MD, MPH Judith S. Currier, MD Karen T. Tashima, MD Marcus Vinícius Guimarães de Lacerda, MD, PhD Sonya L. Heath, MD Michael T. Lu, MD, MPH Alan Landay, PhD George A. Kuchel, MD Pamela S. Douglas, MD Steven K. Grinspoon, MD |
| author_facet | Kristine M. Erlandson, MD, MS Ariela R. Orkaby, MD Triin Umbleja, MSc Heather J. Ribaudo, PhD Todd T. Brown, MD, PhD Markella V. Zanni, MD Marissa R. Diggs, AB Sarah M. Chu, MSN Kathleen V. Fitch, MSN Carl J. Fichtenbaum, MD Carlos Malvestutto, MD, MPH Judith A. Aberg, MD Gerald S. Bloomfield, MD, MPH Judith S. Currier, MD Karen T. Tashima, MD Marcus Vinícius Guimarães de Lacerda, MD, PhD Sonya L. Heath, MD Michael T. Lu, MD, MPH Alan Landay, PhD George A. Kuchel, MD Pamela S. Douglas, MD Steven K. Grinspoon, MD |
| author_sort | Kristine M. Erlandson, MD, MS |
| collection | DOAJ |
| description | Background: People with HIV (PWH) are at increased risk for atherosclerotic cardiovascular diseases (ASCVDs) and geriatric syndromes, including frailty. REPRIEVE (Randomized Trial to Prevent Vascular Events in HIV) demonstrated a 36% reduction in major adverse cardiovascular events (MACE) with pitavastatin vs placebo but the role of statins for ASCVD prevention among frail PWH is not known. Objectives: The purpose of this study was to evaluate whether frailty is associated with MACE and whether pitavastatin prevents MACE regardless of frailty. Methods: We conducted a post hoc analysis of the REPRIEVE trial, a randomized, blinded trial of pitavastatin 4 mg vs placebo. Participants included PWH without ASCVD, aged 40 to 75 years. Frailty was measured with a 32-item frailty index. Cox proportional hazards models were used to estimate cause-specific hazard of MACE by frailty status. Pitavastatin effect modification by frailty status was assessed via interaction with treatment. Results: Of 7769 REPRIEVE participants, 7,740 (>99%) had sufficient data to calculate frailty index. Median age was 50 years (Q1, Q3: 45, 55), 67% were nonfrail, 29% prefrail, and 4% frail at baseline; median follow-up was 5.6 years. Adjusted for age, sex, ASCVD risk score, and treatment group, MACE hazard increased with frailty (P < 0.0001): HR: 1.76 (95% CI: 1.35-2.30) among prefrail, and 2.14 (95% CI: 1.33-3.45) among frail compared to nonfrail. There was no evidence that pitavastatin effect differed by frailty status (P = 0.44). Conclusions: Frailty was associated with markedly higher hazard of MACE. Though frailty did not appear to modify the protective effects of pitavastatin seen in the primary trial, the efficacy in frail PWH remains uncertain due to the limited number of frail individuals. |
| format | Article |
| id | doaj-art-491fba4e3061436dafbbe8efe0f5038d |
| institution | Kabale University |
| issn | 2772-963X |
| language | English |
| publishDate | 2025-09-01 |
| publisher | Elsevier |
| record_format | Article |
| series | JACC: Advances |
| spelling | doaj-art-491fba4e3061436dafbbe8efe0f5038d2025-08-22T04:58:59ZengElsevierJACC: Advances2772-963X2025-09-014910207710.1016/j.jacadv.2025.102077Frailty, Pitavastatin, and Major Adverse Cardiovascular Events Among People With HIVKristine M. Erlandson, MD, MS0Ariela R. Orkaby, MD1Triin Umbleja, MSc2Heather J. Ribaudo, PhD3Todd T. Brown, MD, PhD4Markella V. Zanni, MD5Marissa R. Diggs, AB6Sarah M. Chu, MSN7Kathleen V. Fitch, MSN8Carl J. Fichtenbaum, MD9Carlos Malvestutto, MD, MPH10Judith A. Aberg, MD11Gerald S. Bloomfield, MD, MPH12Judith S. Currier, MD13Karen T. Tashima, MD14Marcus Vinícius Guimarães de Lacerda, MD, PhD15Sonya L. Heath, MD16Michael T. Lu, MD, MPH17Alan Landay, PhD18George A. Kuchel, MD19Pamela S. Douglas, MD20Steven K. Grinspoon, MD21Department of Medicine, University of Colorado Denver- Anschutz Medical Campus, Aurora, Colorado, USA; Address for correspondence: Dr Kristine M. Erlandson, University of Colorado Anschutz Medical Campus, 12700 E. 19th Avenue, Mail Stop B168 Aurora, Colorado 80045, USA.New England GRECC (Geriatric Research, Education, and Clinical Center), VA Boston Healthcare System, Boston, Massachusetts, USA; Division of Aging, Department of Medicine, Brigham & Women’s Hospital and Harvard Medical School, Boston, Massachusetts, USADepartment of Biostatistics, Harvard TH Chan School of Public Health, Boston, Massachusetts, USADepartment of Biostatistics, Harvard TH Chan School of Public Health, Boston, Massachusetts, USADepartment of Medicine, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USAMetabolism Unit, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USAMetabolism Unit, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USAMetabolism Unit, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USAMetabolism Unit, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USADepartment of Medicine, University of Cincinnati College of Medicine, Cincinnati, Ohio, USADepartment of Medicine, Ohio State University Medical Center, Columbus, Ohio, USADepartment of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USADuke Clinical Research Institute, Duke Global Health Institute and Department of Medicine, Duke University, Durham, North Carolina, USADepartment of Medicine, University of California Los Angeles, Los Angeles, California, USADepartment of Medicine, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USAFundação de Medicina Tropical Dr Heitor Vieira Dourado and Fiocruz, Manaus, BrazilDepartment of Medicine, University of Alabama Birmingham School of Medicine, Birmingham, Alabama, USACardiovascular Imaging Research Center, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USADepartment of Medicine, University of Texas Galveston Branch, Galveston, Texas, USADepartment of Medicine, University of Connecticut, Farmington, Connecticut, USADuke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina, USADepartment of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USABackground: People with HIV (PWH) are at increased risk for atherosclerotic cardiovascular diseases (ASCVDs) and geriatric syndromes, including frailty. REPRIEVE (Randomized Trial to Prevent Vascular Events in HIV) demonstrated a 36% reduction in major adverse cardiovascular events (MACE) with pitavastatin vs placebo but the role of statins for ASCVD prevention among frail PWH is not known. Objectives: The purpose of this study was to evaluate whether frailty is associated with MACE and whether pitavastatin prevents MACE regardless of frailty. Methods: We conducted a post hoc analysis of the REPRIEVE trial, a randomized, blinded trial of pitavastatin 4 mg vs placebo. Participants included PWH without ASCVD, aged 40 to 75 years. Frailty was measured with a 32-item frailty index. Cox proportional hazards models were used to estimate cause-specific hazard of MACE by frailty status. Pitavastatin effect modification by frailty status was assessed via interaction with treatment. Results: Of 7769 REPRIEVE participants, 7,740 (>99%) had sufficient data to calculate frailty index. Median age was 50 years (Q1, Q3: 45, 55), 67% were nonfrail, 29% prefrail, and 4% frail at baseline; median follow-up was 5.6 years. Adjusted for age, sex, ASCVD risk score, and treatment group, MACE hazard increased with frailty (P < 0.0001): HR: 1.76 (95% CI: 1.35-2.30) among prefrail, and 2.14 (95% CI: 1.33-3.45) among frail compared to nonfrail. There was no evidence that pitavastatin effect differed by frailty status (P = 0.44). Conclusions: Frailty was associated with markedly higher hazard of MACE. Though frailty did not appear to modify the protective effects of pitavastatin seen in the primary trial, the efficacy in frail PWH remains uncertain due to the limited number of frail individuals.http://www.sciencedirect.com/science/article/pii/S2772963X25005022frailtyHIVmajor adverse cardiovascular eventstatin |
| spellingShingle | Kristine M. Erlandson, MD, MS Ariela R. Orkaby, MD Triin Umbleja, MSc Heather J. Ribaudo, PhD Todd T. Brown, MD, PhD Markella V. Zanni, MD Marissa R. Diggs, AB Sarah M. Chu, MSN Kathleen V. Fitch, MSN Carl J. Fichtenbaum, MD Carlos Malvestutto, MD, MPH Judith A. Aberg, MD Gerald S. Bloomfield, MD, MPH Judith S. Currier, MD Karen T. Tashima, MD Marcus Vinícius Guimarães de Lacerda, MD, PhD Sonya L. Heath, MD Michael T. Lu, MD, MPH Alan Landay, PhD George A. Kuchel, MD Pamela S. Douglas, MD Steven K. Grinspoon, MD Frailty, Pitavastatin, and Major Adverse Cardiovascular Events Among People With HIV JACC: Advances frailty HIV major adverse cardiovascular event statin |
| title | Frailty, Pitavastatin, and Major Adverse Cardiovascular Events Among People With HIV |
| title_full | Frailty, Pitavastatin, and Major Adverse Cardiovascular Events Among People With HIV |
| title_fullStr | Frailty, Pitavastatin, and Major Adverse Cardiovascular Events Among People With HIV |
| title_full_unstemmed | Frailty, Pitavastatin, and Major Adverse Cardiovascular Events Among People With HIV |
| title_short | Frailty, Pitavastatin, and Major Adverse Cardiovascular Events Among People With HIV |
| title_sort | frailty pitavastatin and major adverse cardiovascular events among people with hiv |
| topic | frailty HIV major adverse cardiovascular event statin |
| url | http://www.sciencedirect.com/science/article/pii/S2772963X25005022 |
| work_keys_str_mv | AT kristinemerlandsonmdms frailtypitavastatinandmajoradversecardiovasculareventsamongpeoplewithhiv AT arielarorkabymd frailtypitavastatinandmajoradversecardiovasculareventsamongpeoplewithhiv AT triinumblejamsc frailtypitavastatinandmajoradversecardiovasculareventsamongpeoplewithhiv AT heatherjribaudophd frailtypitavastatinandmajoradversecardiovasculareventsamongpeoplewithhiv AT toddtbrownmdphd frailtypitavastatinandmajoradversecardiovasculareventsamongpeoplewithhiv AT markellavzannimd frailtypitavastatinandmajoradversecardiovasculareventsamongpeoplewithhiv AT marissardiggsab frailtypitavastatinandmajoradversecardiovasculareventsamongpeoplewithhiv AT sarahmchumsn frailtypitavastatinandmajoradversecardiovasculareventsamongpeoplewithhiv AT kathleenvfitchmsn frailtypitavastatinandmajoradversecardiovasculareventsamongpeoplewithhiv AT carljfichtenbaummd frailtypitavastatinandmajoradversecardiovasculareventsamongpeoplewithhiv AT carlosmalvestuttomdmph frailtypitavastatinandmajoradversecardiovasculareventsamongpeoplewithhiv AT judithaabergmd frailtypitavastatinandmajoradversecardiovasculareventsamongpeoplewithhiv AT geraldsbloomfieldmdmph frailtypitavastatinandmajoradversecardiovasculareventsamongpeoplewithhiv AT judithscurriermd frailtypitavastatinandmajoradversecardiovasculareventsamongpeoplewithhiv AT karenttashimamd frailtypitavastatinandmajoradversecardiovasculareventsamongpeoplewithhiv AT marcusviniciusguimaraesdelacerdamdphd frailtypitavastatinandmajoradversecardiovasculareventsamongpeoplewithhiv AT sonyalheathmd frailtypitavastatinandmajoradversecardiovasculareventsamongpeoplewithhiv AT michaeltlumdmph frailtypitavastatinandmajoradversecardiovasculareventsamongpeoplewithhiv AT alanlandayphd frailtypitavastatinandmajoradversecardiovasculareventsamongpeoplewithhiv AT georgeakuchelmd frailtypitavastatinandmajoradversecardiovasculareventsamongpeoplewithhiv AT pamelasdouglasmd frailtypitavastatinandmajoradversecardiovasculareventsamongpeoplewithhiv AT stevenkgrinspoonmd frailtypitavastatinandmajoradversecardiovasculareventsamongpeoplewithhiv |