Factors Affecting Risk of CVD Events in a Global CVD Prevention Cohort of People with HIV.

Background: PWH face increased risks of major adverse cardiovascular disease (MACE), partially mitigated by statin therapy.

Methods: We characterized factors associated with MACE and MACE subcomponents among a global cohort of PWH in REPRIEVE. Our primary outcome measure was time-to-first primary MACE. Secondary outcome measures included time-to-first: a)hard MACE [cardiovascular disease (CVD) death, myocardial infarction (MI), or stroke]; b)MI; or c)stroke. For each outcome, Cox proportional hazards models were used to estimate the hazard of baseline risk factors.

Results: Among participants (N=7,769), median age was 50(Q1,Q3: 45,55) years, 31% female sex-at-birth (sex), 53% residence in high-income countries (HIC), median 10-year PCE ASCVD risk score 4.5(2.1,7.0)%. In fully adjusted models, risk for first MACE was higher for older individuals (50-59 and ≥60 vs. 40-49, HR's(95%CI's): 2.06(1.54,2.76) and 2.53(1.60,4.01)) and for those with Black or African American race (vs. white race, within HIC, HR: 1.65(1.19,2.27)), family history of premature CVD (HR: 1.53(1.16,2.03)), current cigarette smoking (HR: 2.27(1.65,3.13)), hypertension (HR: 1.77(1.36,2.30)), lower HDL cholesterol (HR: 1.21(1.10,1.34)), HIV-1 RNA ≥lower-limit-of-quantification (LLQ) (HR:1.40(1.0,1.97)), and a select ART regimen class combination (HR:1.53(1.01,2.31)). Individuals from HIC had a higher risk of first MACE vs. those from other regions, excepting South Asia. There was no apparent protective effect of female sex. Modelling for hard MACE, MI, and stroke yielded generally similar results for most variables.

Conclusions: Among PWH in REPRIEVE, modifiable risk factors associated with first MACE after accounting for statin effect included cigarette smoking, hypertension, lower HDL cholesterol, and HIV-1 RNA ≥LLQ. Female sex was not protective.