Impact of long-term statin therapy on coronary atherosclerosis in inflammatory joint diseases

  • Svanteson M & al.
  • PLoS ONE
  • 1 Jan 2019

  • curated by Sarfaroj Khan
  • UK Clinical Digest
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Takeaway

  • Patients with inflammatory joint diseases (IJD) treated with long term statin therapy showed progression in total atherosclerotic plaque volume.
  • However, statin therapy reduced soft/mixed unstable plaque volume and increased calcified plaque volume suggesting an alteration in plaque composition.
  • Patients with recommended low-density lipoprotein-cholesterol (LDL-c) levels 1.8 mmol/L).

Why this matters

  • Findings support the benefits of treatment to guideline-recommended lipid targets in patients with IJD.

Study design

  • ROsuvastatin in Rheumatoid Arthritis, Ankylosing Spondylitis and other inflammatory joint diseases (RORA-AS) study included 68 patients with IJD and carotid artery plaques who underwent coronary computed tomography angiography before and after long-term statin therapy.
  • Changes in plaque volume (calcified, mixed/soft and total) and coronary artery calcification (CAC) were evaluated using the 17-segment American Heart Association-model.
  • Funding: None.

Key results

  • After long-term statin therapy:
    • median increase in CAC was 38 (interquartile range [IQR], 5-236) Agatston units (P<.001>
    • calcified and total plaque volume increased with 5.6 (IQR, 0.0-49.1) mm3 and 2.9 (IQR, 0.0-23.5) mm respectively (P<.001 for both>
    • Median change in soft/mixed plaque volume was −10 (IQR, −7.1 to 0.0); P=.001.
    • Patients with the LDL-c treatment target (≤1.8 mmol/L) had a significant reduction in CAC (21 [IQR, 2-143] vs 69 [IQR, 16-423]; P<.001 and total plaque volume to mm>3 vs 13.0 [0.0-60.8] mm3; P<.001 compared with patients recommended ldl-c level>1.8 mmol/L).

Limitations

  • Lack of placebo-controlled arm.
  • Loss of 15 patients to follow-up may have influenced results.