Patients with rheumatoid arthritis are likely to experience the same level of cardiovascular benefits from statins as other individuals without incurring additional risks, according to new research.
The findings of a large clinical trial carried out by researchers at institutions including the University of Dundee appear in Arthritis & Rheumatology.
Patients with rheumatoid arthritis have an approximately 50% higher risk of experiencing cardiovascular events such as heart attack and stroke. By lowering cholesterol, statins are known to help prevent cardiovascular events in certain high-risk individuals but it was unclear whether they are safe and effective for patients with inflammatory conditions such as rheumatoid arthritis.
To investigate the potential risks and benefits of statins in moderate risk patients with rheumatoid arthritis, researchers compared the statin atorvastatin with a placebo. At the end of the trial, patients taking atorvastatin had significantly lower cholesterol as well as significantly lower levels of C-reactive protein, a marker of inflammation, compared with patients taking the placebo. Adverse events in the atorvastatin and placebo groups were similar.
Dundee’s Professor Jill Belch, co-senior author of the paper, said, “It was important to establish that statins were safe for rheumatoid arthritis patients to take and that they experience the same kind of benefits from taking them as the general population.
“Our trial found that levels of cholesterol were reduced by similar amounts as in other populations and that it was indeed safe for these patients. This is a result of some clinical significance and could lead to improved outcomes for individuals with rheumatoid arthritis.”
The trial included 3,002 patients with rheumatoid arthritis who were over aged 50 years or had rheumatoid arthritis for more than 10 years, without clinical atherosclerosis, diabetes, or myopathy. Patients were randomised to receive atorvastatin 40mg daily or placebo.
During a median follow-up of 2.5 years, 1.6% of patients who received atorvastatin and 2.4% of patients receiving placebo experienced cardiovascular death, heart attack, stroke, transient ischemic attack, or any arterial revascularisation. After adjustments, there was a 40% lower risk of cardiovascular events for patients taking atorvastatin, although the difference was not statistically significant. This was because the overall rate of events was low.
Professor Belch carried out the project in conjunction with Professor George Kitas, of Dudley Group NHS Foundation Trust, and Professor Deborah Symmons, of the University of Manchester.
The study authors recommend that patients with rheumatoid arthritis be prescribed statins according to national or local guidelines for managing cardiovascular risk in the general population.
An accompanying editorial in Arthritis & Rheumatology notes that the study provides information that will prove useful for researchers and clinicians who focus on rheumatoid arthritis, and the results may be helpful when considering cardiovascular risk across other rheumatic diseases.