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Statins May Not be Associated with a Reduction in Primary Cardiovascular Events in Patients with Systemic Lupus

Lea R Goren, Michelle Petri, Andrea Fava

    Medrxiv : the Preprint Server for Health Sciences
    |July 10, 2026
    PubMed

    Insights

    For patients with Systemic Lupus Erythematosus (SLE), statins may not prevent cardiovascular events (CVEs). Increased risk was linked to prednisone, diabetes, and higher BMI, not statin use.

    Area of Science:

    • Rheumatology and Cardiology
    • Clinical Epidemiology
    • Pharmacological Research

    Background:

    • Cardiovascular disease (CVD) is a major cause of death in Systemic Lupus Erythematosus (SLE) patients.
    • Statins are standard for primary CVD prevention in the general population, but their efficacy in SLE is uncertain.

    Purpose of the Study:

    • To determine if statins offer protection against first-time cardiovascular events (CVEs) in SLE patients.
    • To investigate the role of traditional and SLE-specific risk factors in CVE development.

    Main Methods:

    • Retrospective analysis of a prospective SLE cohort (n=1396) with follow-up starting in 2013.
    • Cardiovascular events (CVEs) defined as myocardial infarction, stroke, angina, or coronary bypass.
    • Statin use quantified by defined daily doses (DDD); analysis used pooled logistic regression and multivariable models.

    Main Results:

    • No significant difference in CVE rates (per 1000 person-years) between statin non-users (5.3), low-dose users (8.5), and standard-dose users (8.0) (p=0.31).
    • Multivariable analysis showed no protective effect of statins (OR 1.48; p=0.21883).
    • Elevated BMI (25-30 kg/m²) and prednisone use (≥10 mg/day) were associated with higher CVE rates; diabetes mellitus was an independent risk factor (OR 4.48; p=0.00029).

    Conclusions:

    • Statin use may not provide primary prevention benefits for CVEs in SLE patients.
    • Prednisone, diabetes mellitus, and elevated BMI are significant drivers of cardiovascular risk in SLE.
    • Findings align with trials showing statins do not reduce atherosclerosis or normalize pro-atherogenic changes in SLE.
    Abstract

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