Statins Safe, Effective in Rheumatoid Arthritis Patients
However, cardiovascular event rates are low, do not require a primary prevention strategy for all patients
FRIDAY, April 19, 2019 (Pharmacist's Briefing) -- Daily atorvastatin is safe for the primary prevention of cardiovascular events (CVE) in patients with rheumatoid arthritis, conferring a similar degree of risk reduction in these patients as in other populations, according to a study published online April 15 in Arthritis & Rheumatology.
George D. Kitas, M.D., Ph.D., from the Dudley Group NHS Foundation Trust in the United Kingdom, and colleagues evaluated the effectiveness of atorvastatin versus placebo for the primary prevention of CVE in rheumatoid arthritis patients. Patients aged >50 years or with rheumatoid arthritis duration >10 years who were free of clinical atherosclerosis, diabetes, or myopathy at baseline were randomly assigned to either atorvastatin (40 mg daily) or placebo. The trial was terminated early for "futility" due to the lower-than-expected event rate.
The researchers report that 3,002 patients (mean age, 61 years; 74 percent female) were followed for a median 2.51 years. At the early termination, the event rate was 0.77 percent per annum. In the atorvastatin group, 24 of 1,504 patients had the primary end point (a composite of cardiovascular death, myocardial infarction, stroke, transient ischemic attack, or any arterial revascularization) versus 36 of 1,498 in the placebo group (hazard ratio, 0.66; 95 percent confidence interval, 0.39 to 1.11; P = 0.115; adjusted hazard ratio, 0.60; 95 percent confidence interval, 0.32 to 1.15; P = 0.127). At trial end, low-density lipoprotein cholesterol (LDL-C) and C-reactive protein were significantly lower in the atorvastatin group compared with placebo (P < 0.0001 for both). Per mmol/L LDL-C, CVE risk reduction was 42 percent. Adverse events were similar between the groups.
"CVE rates are reducing in this population: this requires further investigation and does not support a primary prevention strategy involving statin use in all rheumatoid arthritis patients," the authors write.
Several authors disclosed financial ties to pharmaceutical companies, including Pfizer, which provided drugs for the study and funds to establish the biobank.