Starting Statins: Why Your Doctor May Recommend Cholesterol Medicine

Antiretroviral therapy (ART) has been so effective at treating people living with HIV that they have roughly the same life expectancy as those without HIV. As more people with HIV live longer, the relationship between HIV and other diseases has become clearer.¹

For example, people living with HIV have double the risk of developing atherosclerotic cardiovascular disease (ASCVD) than those without HIV. They also are more likely to be diagnosed with ASCVD 10 years earlier than those without HIV. ASCVD can lead to heart attack and stroke.¹

What is ASCVD?

Cardiovascular disease affects most adults over 60 years old. ASCVD is one form of cardiovascular disease that is caused by atherosclerosis. Atherosclerosis refers to the buildup of fat in the blood vessels. This buildup can begin in people as young as 20 or 30 years old. As you age, this fat can calcify, or become hard.²

The areas where calcified fat builds up are called plaques. Plaques can block blood from moving down blood vessels. They can also make it difficult for blood vessels to expand or contract, which is important for controlling blood pressure.²

When a blood vessel in the heart becomes blocked and that area of the heart does not receive blood, ASCVD can lead to a heart attack. Plaques can also break off and travel, blocking other blood vessels and causing other complications like strokes.²

Why is ASCVD related to HIV?

People living with HIV may be more likely to have risk factors that contribute to developing ASCVD. Risk factors for ASCVD include:³

1. High cholesterol
2. Smoking
3. Diabetes
4. Obesity

However, these risk factors do not fully explain the increased risk in people living with HIV. Experts believe that HIV may cause inflammation in the blood vessels. Plaques may form in areas where there is inflammation.³

Can ASCVD be prevented?

Prevention of ASCVD is usually focused on reducing risk factors. This often includes lifestyle changes like eating a healthy diet, getting consistent exercise, and avoiding tobacco. It also includes taking medicines to reduce high blood pressure and reduce cholesterol. Drugs that control cholesterol are called statins.¹

What are statins?

Statins are a well-known and well-studied type of drug. They are the most effective drugs to prevent diseases related to high cholesterol, including heart attack and stroke.⁴

These drugs usually have the word "statin" in their name, such as atorvastatin or pitavastatin. They work by decreasing how much cholesterol your body makes. They can help lower both LDL cholesterol and triglycerides, 2 forms of cholesterol that are linked to ASCVD. They can also help reduce inflammation.⁴

Statins and HIV

Because of the increased risk of ASCVD for those living with HIV, your doctor may recommend a statin. The most studied statin for those living with HIV is pitavastatin.³

Pitavastatin does not interact with the ART drugs used to treat HIV. It also does not increase blood sugar like other statins can. Pitavastatin has been shown to reduce LDL cholesterol and reduce the inflammation that may cause ASCVD.³

If you have more questions about your ASCVD risk or you believe you may benefit from starting statins, speak to your doctor.