Atorvastatin a promising cardioprotective agent in rheumatoid arthritis
Use of atorvastatin in patients with rheumatoid arthritis (RA) is safe and leads to substantial reductions in low-density lipoprotein (LDL) cholesterol, which translates to a 40-percent decrease in the risk of cardiovascular events, according to data from the TRACE RA trial.
TRACE-RA randomized 3,002 RA patients (mean age, 61 years; 74 percent female) to receive atorvastatin 40 mg daily or matching placebo. None of the patients had clinical atherosclerosis, diabetes or myopathy.
Over a median follow-up of 2.51 years, the primary endpoint of a composite of cardiovascular death, myocardial infarction, stroke, transient ischaemic attack or any arterial revascularization occurred in 24 patients in the atorvastatin group and in 36 patients in the placebo group (1.6 percent vs 2.4 percent, respectively; adjusted hazard ratio, 0.60; 95 percent CI, 0.32–1.15; p=0.127).
The trial was terminated prematurely due to lower than expected event rate (0.77 percent per annum).
Results for the secondary endpoint of plasma lipids favoured atorvastatin. Compared with placebo, the statin yielded greater reductions in mean LDL cholesterol (2.21 vs 2.98 mmol/L; p<0.0001) and mean C-reactive protein (2.59 vs 3.60 mg/L; p<0.0001).
Every 1-mmol/L decrease in LDL cholesterol was associated with a 42-percent reduction in the risk of cardiovascular events.
Adverse events occurred similarly in the atorvastatin and placebo groups (19.8 percent vs 19.5 percent).
The findings suggest that once-daily atorvastatin 40 mg is safe for the primary prevention of cardiovascular events in patients with RA, conferring a similar magnitude of risk reduction in these patients as in other populations, researchers said.