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Published on: November 10, 2017
Effect of intensive lipid-lowering therapy on cardiovascular outcome in patients with and those without inflammatory
Anne Grete Semb1, Tore K Kvien, David A DeMicco
1Diakonhjemmet Hospital, Oslo, Norway. anne.semb@yahoo.no
Insights
Intensive statin therapy effectively lowers cardiovascular disease (CVD) risk in patients with inflammatory joint diseases like rheumatoid arthritis (RA), ankylosing spondylitis (AS), and psoriatic arthritis (PsA). These patients experienced similar lipid reductions and CVD risk reduction compared to those without these conditions.
Area of Science:
- Cardiology
- Rheumatology
- Pharmacology
Background:
- Patients with inflammatory joint diseases (IJD) such as rheumatoid arthritis (RA), ankylosing spondylitis (AS), and psoriatic arthritis (PsA) may have altered cardiovascular disease (CVD) risk.
- The impact of intensive lipid-lowering therapy on CVD outcomes in these specific patient populations requires further investigation.
Purpose of the Study:
- To evaluate the efficacy of intensive lipid-lowering therapy using statins in reducing cardiovascular disease (CVD) events in patients with RA, AS, or PsA.
- To compare the effects of intensive statin therapy on lipid levels and CVD risk between patients with and without inflammatory joint diseases.
Main Methods:
- Post hoc analysis of two prospective trials (Treating to New Targets [TNT] and Incremental Decrease in End Points Through Aggressive Lipid Lowering [IDEAL]) involving 18,889 patients.
- Stratified analysis of 199 RA, 46 AS, and 35 PsA patients receiving intensive atorvastatin (80 mg) versus conventional/low-dose statins.
- Lipid level changes assessed by ANCOVA; CVD event risk evaluated using Cox regression analyses.
Main Results:
- Patients with RA and AS exhibited lower baseline cholesterol levels compared to those without IJD.
- Intensive statin therapy resulted in comparable reductions in lipid levels across all patient groups.
- A 20% reduction in the overall risk of CVD was observed in both patients with and without inflammatory joint diseases.
Conclusions:
- Intensive statin treatment provides comparable lipid-lowering effects and cardiovascular disease (CVD) risk reduction in patients with and without inflammatory joint diseases.
- These findings support the use of intensive lipid-lowering strategies in managing CVD risk in patients with RA, AS, and PsA.
Objective:
To examine the effect of intensive lipid-lowering therapy on a composite cardiovascular outcome (cardiovascular disease [CVD]), consisting of mortality and morbidity end points, in patients with inflammatory joint disease (rheumatoid arthritis [RA], ankylosing spondylitis [AS], or psoriatic arthritis [PsA]) by post hoc analysis of 2 prospective trials of statins with a secondary end point of CVD outcome (the Treating to New Targets [TNT] and Incremental Decrease in End Points Through Aggressive Lipid Lowering [IDEAL] studies).
Methods:
Of the 18,889 patients participating in the 2 trials, 199 had RA, 46 had AS, and 35 had PsA. Lipid-lowering therapy consisted of an intensive regimen of atorvastatin 80 mg or a conventional/low-dose regimen of atorvastatin 10 mg or simvastatin 20-40 mg. The median duration of followup was nearly 5 years. Changes in lipid levels were examined by analyses of covariance. The effect on CVD was examined by Cox regression analyses, and heterogeneity tests were performed.
Results:
Patients with RA and those with AS had lower baseline cholesterol levels than patients without inflammatory joint disease (least squares mean ± SEM 180.7 ± 2.3 mg/dl and 176.5 ± 4.7 mg/dl, respectively, versus 185.6 ± 0.2 mg/dl; P = 0.03 and P = 0.05, respectively). Statin treatment led to a comparable decrease in lipid levels and a 20% reduction in overall risk of CVD in both patients with and those without inflammatory joint disease.
Conclusion:
Our findings indicate that patients with and those without inflammatory joint disease experience comparable lipid-lowering effects and CVD risk reduction after intensive treatment with statins.
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