Statins are safe for rheumatoid arthritis patients

A clinical study has indicated that statins are completely safe for rheumatoid arthritis patients and do not pose an additional risk.

The research was published in the journal Arthritis & Rheumatology.

Patients with rheumatoid arthritis have an approximately 50 per cent higher risk of experiencing cardiovascular events such as heart attack and stroke compared with the general population.

Statins are known to help prevent such occurrences in certain high-risk individuals by lowering LDL cholesterol. But it's 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 designed the Trial of Atorvastatin for the Primary Prevention of Cardiovascular Events in Patients with Rheumatoid Arthritis (TRACE RA), a multi-centre, randomised, double-blind trial comparing the statin atorvastatin with placebo.

The trial included 3,002 patients with rheumatoid arthritis who were over the age of 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 per cent of patients who received atorvastatin and 2.4 per cent of patients receiving placebo experienced cardiovascular death, heart attack, stroke, transient ischemic attack, or any arterial revascularisation.

After adjustments, there was a 40 per cent 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.

At the end of the trial, patients taking atorvastatin had significantly lower LDL cholesterol as well as significantly lower levels of C-reactive protein, a marker of inflammation, compared with patients taking a placebo. Adverse events in the atorvastatin and placebo groups were similar.

The study's lead author is George while co-senior authors are Professor Jill Belch and Professor Deborah Symmons.

"The trial found that the statin reduced levels of cholesterol by similar amounts as have been seen in other populations studied. The results also show that it is as safe for patients with rheumatoid arthritis to take statins as for the general population," said Prof. Symmons.

"In addition, because of the low overall rate of cardiovascular events in the trial population, there is no indication for all patients with rheumatoid arthritis to be prescribed a statin. This is unlike diabetes where the great majority of patients are recommended to take a statin," Prof. Symmons added.

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.

The study provides information that will be useful for researchers and clinicians who focus on rheumatoid arthritis and the results may be helpful when considering cardiovascular risk across other rheumatic diseases.