Adults living with HIV have nearly twice the risk of developing atherosclerotic cardiovascular disease than those who are HIV-negative. Thankfully, new data revealed at the American Heart Association’s Scientific Sessions late last year may help change that frightening statistic.
Atherosclerosis (also known as “clogged arteries”) is a hardening and narrowing of the arteries that slowly blocks blood flow and is the most common cause of heart attacks, strokes, and peripheral vascular diseasewhich, together, are called cardiovascular disease.
Five new analyses from the FOURIER study, conducted by research subgroups of the AHA, were presented at the conference. Research showed that people with the highest risk for cardiovascular events, such as heart attack or stroke, experienced the greatest clinical benefit from a new drug, evolocumab.
Developed by the biotech company Amgen, and branded as Repatha, evolocumab is part of a new class of cholesterol-lowering medications called PCSK9 inhibitors, which have been successful in lowering LDL cholesterol (the “bad cholesterol” that can lead to plaque that clogs arteries) in the body to levels no previous medications, including statins, had been able to reach.
These latest analyses show that LDL levels of participants with peripheral artery disease dropped a whopping 59 percent on evolocumab. The drug also reduced the risk of heart attack by 27 percent in other high-risk patients.
“As we continue to look deeper into the data from the FOURIER study, we are able to identify subsets of patients that can derive even greater clinical benefit from intensive LDL-C lowering with evolocumab, in addition to what is achieved with statins alone,” said Dr. Marc Sabatine, a cardiovascular physician at Brigham and Women’s Hospital in Boston, professor at Harvard Medical School, and lead investigator of the FOURIER study. “These results offer additional ways for clinicians to tailor therapies for their patients to reduce the risk of recurrent cardiovascular events.”
Research over the past several decades has consistently shown that lowering LDL cholesterol reduces the risk for heart attacks and cardiovascular disease. Traditionally, statins (HMG-CoA reductase inhibitors) were prescribed along with lifestyle changes (such as stopping smoking, eating healthier, and exercising) to lower LDL in high-risk patients. Now, researchers are focused on discovering new ways to lower LDL in those who have limited treatment options, including people living with HIV.
Terry Ferguson, the U.S. cardiovascular therapeutic head at Amgen, explained to HIV Equal that poz people are more at risk for heart issues because the disease puts them in “a pro-inflammatory state, much in the same way as people with rheumatoid arthritis. I think that there’s more appreciation that this inflammation predisposes people to more rapid progression and higher risk of atherosclerotic disease.”
Due to this added cardiovascular risk, a more aggressive cholesterol-lowering therapy can truly be life-saving for people living with HIV. Another problem has been that many HIV medications, particularly protease inhibitors, increase the side effects of statins (which can include debilitating muscle pain).
“These analyses add to the growing body of evidence that Repatha significantly and consistently reduces cardiovascular event risk across a spectrum of high-risk cardiovascular patients,” said Dr. Sean E. Harper, executive vice president of research and development at Amgen. “The proven efficacy of Repatha to help those with established cardiovascular disease at high risk for heart attacks and strokes reinforces the importance of achieving and maintaining a low LDL-C level.”
All in all, great news for poz and HIV-negative people alike who have been dealing with these types of heart issuesand another big scientific leap forward in helping people with HIV take control of their health and live long, happy lives.