Estimated major adverse cardiovascular events averted among persons with HIV if treated with a moderate-intensity statin

Objective: To estimate 10-year atherosclerotic cardiovascular disease (ASCVD) risk among U.S. adults with diagnosed HIV (PWH) and number of first major adverse cardiovascular events (MACE) that are potentially preventable over a 5-year period, if U.S. Department of Health and Human Services recommendations for statin therapy for PWH were fully implemented. Design: Cross-sectional study of nationally representative, individual-level data on behavioral and clinical characteristics of U.S. PWH. Methods: Using data from standardized questionnaires and medical records abstraction collected from June 2022—May 2023, we calculated weighted estimates of the following among PWH aged 40–75 years without documented cardiovascular disease (N = 2,155): 10-year ASCVD risk; statin prescription by risk level; number potentially avoidable first MACE over 5 years with moderate-intensity statin treatment. We used the 2013 Pooled Cohort Equation to calculate ASCVD risk. MACE averted was estimated by applying a previously published 5-year number needed to treat to the weighted number of PWH eligible for statin therapy. Results: Among PWH eligible for therapy, 72.5% were male, 42.5% were aged 50−59 years and 35.9% were Black, non-Hispanic persons. The overall median risk score was 7.1% (95% Confidence Interval [CI]: 6.8%–7.4%). Among those with low (<5%) and moderate risk (5%−<20%), 19.8% (16.7%–22.9%) and 36.9% (33.4%–40.4%) were on statin therapy, respectively. An estimated 7,418 (95% CI: 1,116 –13,909) additional first MACE could be prevented over 5 years if eligible PWH received moderate-intensity statin therapy. Conclusions: Fully implementing statin therapy recommendations for PWH in the United States could substantially reduce MACE among this population.