Statins for prevention of cardiovascular disease in systemic lupus erythematosus

In systemic lupus erythematosus (SLE), cardiovascular disease (CVD) is an important cause of long-term morbidity, which could be affected by statin use. Here we review the evidence for the use of statins for the prevention of CVD in patients with SLE.

The PubMed database was searched using a query combining SLE and statins.

The search yielded nine relevant clinical studies. Seven studies reported on radiological findings that correlate with atherosclerosis and mainly revealed that statin treatment resulted in a slight decrease in progression of carotid intima-media thickness and an increase in flow-mediated vasodilatation. Two studies investigated CVD and mortality. In a group of SLE patients that had received a kidney transplantation, three of 23 statin-treated SLE patients experienced cardiac events compared with four of ten placebo- reated controls. Moreover, in a retrospectively studied cohort of SLE patients with dyslipidaemia, statin treatment in 777 patients was associated with a large decrease in coronary heart disease (hazard ratio [HR] = 0.20), cerebrovascular disease (HR = 0.14), end-stage renal disease (HR = 0.22) and mortality (HR = 0.44) compared with 1317 patients that had not been prescribed statins. However, the latter retrospective study was subject to bias and causality can only be proven in a randomised trial. Statins showed a good safety profile in SLE patients.

Whilst awaiting new prospective randomised studies, we recommend prescription of statins in SLE patients with increased cardiovascular risk according to the current recommendations for cardiovascular risk management in rheumatoid arthritis.