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Prevention & lipidsSecondary analysis

Inflammatory, Cardiac, and Lipid-Related Biomarkers in Relation to Residual Major Adverse Cardiovascular Event (MACE) Risk in the REPRIEVE Trial

JACC AdvPublished

  • Secondary analysis of the REPRIEVE global primary cardiovascular prevention trial
  • residual risk analyses
  • Cox models adjusted for randomized statin treatment and atherosclerotic cardiovascular disease (CVD) risk
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Authors' conclusion

Among PWH with low-moderate predicted CVD risk and well-controlled HIV, persistent inflammation, innate immune activation, and subclinical cardiac dysfunction are common, and strongly relate to residual MACE risk, accounting for a large PAF. (Evaluating the Use of Pitavastatin to Reduce the Risk of Cardiovascular Disease in HIV-Infected Adults [REPRIEVE]; NCT02344290.

Study context

Population
Contemporary antiretroviral therapy-treated people with HIV (PWH) in the REPRIEVE trial(90%) of the 7769 REPRIEVE participants had biomarker data available at baseline
Participants
7,005 people
Comparison
Highest vs lowest baseline biomarker levels in relation to incident MACE

Primary result

As reported in the abstract

Elevated inflammatory and cardiac markers at baseline · baseline

high-sensitivity C-reactive protein >3 mg/L

49%

interleukin [IL]-6 ≥3.3 pg/mL

33%

high-sensitivity troponin ≥6 ng/L

35%

N-terminal pro-B-type natriuretic peptide ≥50 pg/mL

33%

Further findings

OutcomeHR (95% CI)
Incident MACE by biomarker level · median follow-up of 5.6 years — highest IL-6 levels vs lowest IL-6 levels · adjusted for PCE and statin randomization2.2 (1.3–3.9)
Incident MACE by biomarker level · median follow-up of 5.6 years — highest high-sensitivity troponin levels vs lowest high-sensitivity troponin levels · adjusted for PCE and statin randomization2.2 (1.2–4.1)

Correlation of inflammatory biomarkers with cardiac or lipid biomarkers

Inflammatory biomarkers showed minimal correlation with cardiac or lipid biomarkers (apolipoprotein B-100, oxidized low-density lipoprotein, and lipoprotein(a))

Population attributable fractions for MACE

PAF, IL-6
18.6% (95% CI: 7.4%-30.5%)
PAF, high-sensitivity C-reactive protein
17.2% (95% CI: 1.6%-32.9%)

Original publication

Inflammatory, Cardiac, and Lipid-Related Biomarkers in Relation to Residual MACE Risk in the REPRIEVE Trial. JACC Adv. Published 10 July 2026. doi:10.1016/j.jacadv.2026.102984
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Summarised from the published abstract; every number is checked against it