Statin use did not affect risk of myocardial infarction (MI), stroke and all-cause mortality in a retrospective study of 438 people taking combination antiretroviral therapy. But a higher CD4 count did lower the risk of that combined endpoint in the study, which analyzed data from the U.S. Nutrition for Healthy Living (NFHL) cohort.
Systemic inflammation and metabolic abnormalities persist in people responding well to combination antiretroviral therapy and may contribute to cardiovascular disease and other non-AIDS comorbidities. To see if the anti-inflammatory and anti-lipid impact of statins could affect those outcomes, as well as mortality, NFHL investigators conducted this retrospective analysis.
NFHL is a prospective cohort that began enrolling HIV-positive adults in 1995, excluding people with uncontrolled hypertension, MI or stroke within the past six months, but keeping cohort members in whom those conditions developed after they entered NFHL. This analysis focused on people who began combination antiretroviral therapy in September 2000 or later. The investigators compared the incidence of MI, stroke and all-cause mortality (a composite endpoint) in people who took statins versus those who did not. To identify the factors associated with reaching the composite endpoint, the investigators used two Cox proportional hazards models: one focused on statin use as a binary (yes-or-no) variable and one considering statin duration. Other time-varying predictors in the model were CD4 count and low-density lipoprotein (LDL) cholesterol.