Statins for primary prevention of cardiovascular events in people with HIV: target trial and modelling study

作者：Henock G. Yebyo, Huldrych F. Günthard, Eva Rehfuess, N. Serra, Sarah R. Haile, Oliver Senn, Gregory M. Lucas, Oliver Langselius, Jennifer E. Thorne, Vincent C Marconi, Sally B. Coburn, Raynell Lang, Jonathan Colasanti, Michael J. Silverberg, Sonia Napravnik, Mona Loutfy, Maile Karris, Timothy R. Sterling, Greer Burkholder, Keri N. Althoff, Milo A. Puhan · 发表于：BMJ Medicine · 年份：2025 · DOI：10.1136/bmjmed-2024-001132 · 被引用次数：3 · 研究领域：HIV-related health complications and treatments、Lipoproteins and Cardiovascular Health、HIV Research and Treatment

Objective: To evaluate the effectiveness and benefit-harm balance of various statins for the primary prevention of cardiovascular disease in people with HIV. Design: Target trial and modelling study. Setting: North American AIDS Cohort Collaboration on Research and Design (NA-ACCORD), 1995 to 2019. NA-ACCORD integrates individual level data from >20 HIV cohorts across the US and Canada from people with HIV who have successfully linked into care. Participants: 157 699 people with HIV enrolled in one of the cohorts of NA-ACCORD. 54 165 eligible individuals, aged 40-75 years, were enrolled in the target trial. Main outcome measures: The primary outcomes for the target trial were the 10 year effects of statins on cardiovascular disease events (fatal and non-fatal myocardial infarction, hospital admission for unstable angina, coronary or arterial revascularisation, fatal and non-fatal stroke, or transient ischaemic attack) and harm outcomes (type 2 diabetes, mild cognitive impairment, rhabdomyolysis, and myopathy). The secondary outcome was the 10 year risk threshold where the reduction in cardiovascular disease outweighed the increased risk of harm outcomes, showing an overall net benefit of statins. Results: Participants who first started receiving treatment with statins (statin initiators) had a 21% reduction in cardiovascular disease events (hazard ratio 0.79, 95% confidence interval (CI) 0.72 to 0.87) and a 26% reduction in the combined risk of stroke and myocardial infarctio...