Statins cleared for rheumatoid arthritis patients
Clinical trial allays long-running safety fears. Andrew Masterson reports.
Statins are safe and effective for people with rheumatoid arthritis, a large clinical trial reveals.
Patients with rheumatoid arthritis (RA) carry an increased risk of cardiovascular malfunction, including stroke and heart attack. Statins are by far the most prevalent medication used for preventing these events among the general population.
However, previous research raised questions regarding whether the medication was effective for at-risk people with RA. Heart disease in people with the condition, a 2004 article in The Lancet pointed out, arises “independent of traditional risk factors”.
Another study, published in 2012, found that statin use might even raise the chances of RA developing.
The latest study, led by George Kitas of the UK’s Dudley Group NHS Foundation Trust and published in the journal Arthritis and Rheumatology, makes no finding about whether statins might catalyse AR in previously asymptomatic patients, but delivers a positive endorsement for the med’s benefits in people who already have the condition.
Kitas and colleagues set up a randomised, double-blind trial of the particular medication marketed as Atorvastatin, involving 3002 RA patients at moderate risk of cardiovascular events. Participants were either aged over 50, or had been diagnosed with RA more than 10 years previously.
The cohort was divided into two, with one half receiving a daily 40 milligram statin dose and the other a placebo.
Follow-up investigations two-and-a-half years later found 1.6% of the statin cohort and 2.4% of the placebo cohort had experienced cardiovascular events, including heart attack, stroke, transient ischemic attack and death.
After adjusting for potentially confounding factors, the researchers concluded that RA patients taking statins had a 40% lower risk than those not on the medication – although the numbers were small and the difference thus statistically insignificant.
However, tests showed that the statin-takers had markedly lower LDL cholesterol as well as lower levels of C-reactive protein, a marker of inflammation. Adverse events were similar in both groups.
“The trial found that the statin reduced levels of cholesterol by similar amounts as has been seen in other populations studied,” says co-author Deborah Symmons of the University of Manchester, UK.
“The results also show that it is as safe for patients with rheumatoid arthritis to take statins as for the general population.”
She adds that the low overall number of cardiac events in the full cohort indicated that there was no evidence all patients with RA should routinely be prescribed the medication.
“This is unlike diabetes where the great majority of patients are recommended to take a statin,” she says.