Hypertriglyceridaemia and gender differences in the risk of major adverse cardiovascular events in people with HIV: A single‐centre retrospective longitudinal study

INTRODUCTION People with HIV (PWH) have an elevated risk of major adverse cardiovascular events (MACE) compared to the general population. The independent contribution of hypertriglyceridaemia (HTG) to cardiovascular risk remains unclear, and it is not accounted for in the standard used risk scores. The aim of this study was to evaluate whether HTG is independently associated with MACE, beyond factors included in the Atherosclerotic Cardiovascular Disease (ASCVD) risk score. Moreover, we assessed whether the association between MACE and cardiovascular risk factors, including HTG, is modified by sex.

METHODS This was a retrospective longitudinal study including PWH followed at the San Raffaele Scientific Institute from January 2013 to January 2025. Baseline was defined as the first evaluation from 2013 onwards. A multivariate Cox regression model was used to assess the association between HTG and MACE, adjusting for ASCVD variables, statin use and HIV-related factors. Interaction terms were tested to explore sex-based modification of these associations.

RESULTS Over a median follow-up of 11.4 years, 187 MACE occurred. HTG was independently associated with MACE [hazard ratio 1.53 (1.03; 2.30), p = 0.042], along with variables included in ASCVD risk score, statin use and unsuppressed HIV viraemia. No significant interactions were found between sex and any of the variables, although a marginal interaction was observed for diabetes.

CONCLUSIONS In this large cohort of PWH, HTG was independently associated with MACE, beyond traditional risk factors included in the ASCVD risk score. These findings suggest that triglycerides should be routinely considered in cardiovascular risk evaluation and targeted interventions-such as lifestyle changes and specific triglyceride-lowering therapies-may contribute to the reduction of residual cardiovascular risk.