Do statins reduce the cardiovascular risk in patients with rheumatoid arthritis?

Patients with rheumatoid arthritis (RA) are at significantly higher risk of cardiovascular (CV) morbidity and mortality compared with the general population. Traditional CV risk factors cannot explain the total excess of CV morbidity and mortality in RA patients. At present, it is not clear whether treatment with statins might be of benefit in RA patients. The aim of the present systematic literature review is to summarize the published evidence concerning treatment with statins and its impact on CV events in RA patients.

A systematic literature review of studies on RA and statins was carried out in the database PubMed. Search terms were 'simvastatin OR atorvastatin OR fluvastatin OR lovastatin OR pravastatin OR rosuvastatin OR statin AND arthritis'. Papers were included in this review when the reported outcome was on CV events in RA patients. After exclusion of the studies not fulfilling our inclusion criteria four studies were finally analyzed. The total number of RA patients included in these studies was 4896.

Statins were associated with reduced CV events and mortality in RA in primary prevention but not in secondary prevention. In secondary prevention after myocardial infarction (MI) there was no statistically significant difference between RA or non-RA patients either receiving atorvastatin 80 mg or simvastatin 20-40 mg daily. Treatment with atorvastatin 80 mg led to a reduction in overall risk of CV disease in both patients with and without inflammatory joint disease compared to patients receiving the conventional/low-dose statin treatment. Statin discontinuation in RA patients was associated with an increased risk of acute myocardial infarction or CV mortality. Myalgia, diarrhoea, abdominal pain and nausea may be more frequent in RA patients than in controls.

The published evidence shows that in RA patients statin treatment appears to reduce CV risk in primary prevention and that statin discontinuation is associated with an increased risk for CV events. However, the significance of statin treatment in RA patients still remains unclear as only very little evidence has been published. Whether all RA patients would benefit from treatment with statins still needs to be investigated.