Lipid-lowering Therapies in Myositis

Area of Science:

• Cardiology
• Rheumatology
• Pharmacology

Background:

• Patients with idiopathic inflammatory myopathies (IIM) have an increased risk of atherosclerotic cardiovascular disease (ASCVD).
• Current guidelines lack specific recommendations for managing ASCVD in IIM patients.
• Lipid-lowering therapies, particularly statins, pose unique challenges and potential contraindications in this population.

Purpose of the Study:

• To propose a framework for ASCVD risk assessment and management in IIM patients.
• To outline strategies for monitoring myositis disease activity during lipid-lowering therapy.
• To provide guidance on managing statin intolerance and the use of PCSK9 inhibitors.

Main Methods:

• Review of current American College of Cardiology/American Heart Association (ACC/AHA) guidelines for ASCVD prevention.
• Analysis of evidence regarding lipid-lowering therapies in inflammatory diseases and IIM.
• Synthesis of information on statin contraindications and PCSK9 inhibitor safety and efficacy in IIM.

Main Results:

• ACC/AHA guidelines can be adapted for ASCVD primary prevention in IIM.
• Statin use is contraindicated in patients with anti-HMGCR antibodies.
• PCSK9 inhibitors demonstrate safety and potential benefit in IIM patients.

Conclusions:

• A structured approach is needed for ASCVD management in IIM.
• Careful consideration of lipid-lowering therapy side effects and contraindications is crucial.
• PCSK9 inhibitors represent a viable therapeutic option for select IIM patients with ASCVD risk or intolerance to statins.