title: Myocardial Infarction, Stroke, and Mortality in cART-Treated HIV Patients on Statins.
abstract: Despite combination antiretroviral therapy (cART), people living with HIV (PLWH) continue to have more systemic inflammation and metabolic disturbances than the general population. These risk factors for atherosclerosis and organ dysfunction may be ameliorated by statins. We retrospectively analyzed 438 cART treated PLWH from the Nutrition For Healthy Living (NFHL) cohort to determine the association between statins and myocardial infarction (MI), stroke, and all-cause mortality as a composite. We used Cox proportional hazards regression as our main analysis. The average age was 44 years, 32% were women, and 67 of the 438 subjects used statins. There was no association between statins and our composite endpoint in two separate models [1.26 (0.57-2.79) in statin history model and 0.93 (0.65-1.32) per year in statin duration model]. The composite outcome was significantly associated with CD4 count, age, and smoking status in both models. CD4 count remained significant even after exclusion of mortality from the composite (HR=0.88, p=0.02). Confounding control via propensity scoring and multiple imputations did not change the results. Statins did not have an effect on MI, stroke, and mortality. Interestingly, CD4 count appears to be an important predictor of these outcomes, even after exclusion of death from the composite.
authors: 1Tufts Medical Center and Tufts University, Boston, Massachusetts.
authors: Martin
authors: M
authors: Krsak
authors: 2Predictive Analytics and Comparative Effectiveness (PACE) Center, Tufts Medical Center, Boston, Massachusetts.|3Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, Massachusetts.
authors: David M
authors: DM
authors: Kent
authors: 3Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, Massachusetts.|4Tufts Clinical and Translational Science Institute, Tufts University, Boston, Massachusetts.
authors: Norma
authors: N
authors: Terrin
authors: 1Tufts Medical Center and Tufts University, Boston, Massachusetts.
authors: Christina
authors: C
authors: Holcroft
authors: 1Tufts Medical Center and Tufts University, Boston, Massachusetts.
authors: Sally C
authors: SC
authors: Skinner
authors: 1Tufts Medical Center and Tufts University, Boston, Massachusetts.
authors: Christine
authors: C
authors: Wanke
mesh_terms: D000328:Adult; D023241:Antiretroviral Therapy, Highly Active; D018791:CD4 Lymphocyte Count; D002423:Cause of Death; D005260:Female; D005500:Follow-Up Studies; D015658:HIV Infections / Q000188:drug therapy* / Q000401:mortality; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use; D015994:Incidence; D008297:Male; D009203:Myocardial Infarction / Q000188:drug therapy / Q000453:epidemiology* / Q000401:mortality; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012189:Retrospective Studies; D012307:Risk Factors; D020521:Stroke / Q000188:drug therapy / Q000453:epidemiology* / Q000401:mortality; D016896:Treatment Outcome
chemical_list: D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors