Statins Are Safe to Use for Heart Protection in People With Rheumatoid Arthritis

From everydayhealth.com

People living with RA face an increased risk for heart disease, but a new study suggests a cholesterol-lowering drug used to lower risks is appropriate for some people with RA.

           People with rheumatoid arthritis may have a new way to help protect heart health.

                                                                       Shutterstock (2)

It’s well established that people living with rheumatoid arthritis (RA) are at an increased risk for developing heart disease when compared with people who do not have RA. Yet people with rheumatoid arthritis, a chronic inflammatory joint disease, have been systematically excluded from most previous trials of statins, cholesterol-lowering drugs used to lower risk of cardiac events. A study published online on April 15, 2019, in the journal Arthritis & Rheumatology an official journal of the American College of Rheumatology, decided to take a closer look at the RA population, since they are at heightened risk for heart disease. (Previous research published in Arthritis & Rheumatology found that RA patients have higher rates of atherosclerosis — build-up of fat, cholesterol, and plaque on blood vessel walls — than the general population, which can lead to heart problems.)

Questions People With RA, and Their Doctors, Have Asked

But are statins safe for RA patients to take? And do they minimize the risk of heart disease in the RA population? The answer is yes to the first question — and sort of, to the second.

Stumbling Blocks in the Study on Statins and RA

The study, undertaken at the University of Manchester in England, was designed based on the assumption (taken from published literature) that RA patients recruited to the trial would have 50 percent more heart events than the general population of the United Kingdom (after adjusting for age and sex). However, once the research team got into it, they found they could only recruit patients who were not already on a statin and who did not have any known cardiovascular disease. It turned out that the patients recruited to the trial did not have an increased risk of cardiovascular disease compared with the general population — they saw far fewer heart attacks and strokes, in total, than expected.

Statins Do Protect Against Heart Disease — But Not for Everyone With RA

Deborah Symmons, MD, emerita professor and research lead for prevention of comorbidity at NIHR Manchester Musculoskeletal Biomedical Research Unit, explains: “Statins generally reduce the risk of heart attacks and strokes by around one-third regardless of the starting background risk, as we found in the trial. Our finding was not statistically significant because the total number of heart attacks and strokes was low — lower than we had anticipated when we originally calculated the required sample size for the study. This meant that we found the effect size that we planned for, but it was not statistically significant.”
As a result, the team does not recommend prescribing statins for all members of the RA population because, generally speaking, the benefit of reducing a small risk by one-third is not worth the inconvenience, cost, and possible side effects of taking the medication.

The Good News: Statins Are Safe for People With RA

What they did find is that statins are safe for people living with rheumatoid arthritis to take. What the research team recommends, says Dr. Symmons, is that “RA patients should make sure they have been screened for cardiovascular risk in the same way as the general population and should be prescribed statins according to local and national guidelines. If prescribed statins, they can be reassured from our study that they are no more likely to experience side effects than other members of the general population, and that their cholesterol [levels] will fall to the same extent and they will get the same benefit as anyone else. RA patients who are not judged to require statins according to local guidelines can be reassured that this advice is appropriate for them.”

This Is the First Large Study to Look at Statins and Rheumatoid Arthritis

She adds, “Since RA patients and statins have never been studied in trials before, this is very useful information to know.”

Heart Complications Are Linked to Rheumatoid Arthritis

Rheumatic diseases such as RA increase the risks for developing a variety of health conditions. The most common comorbidity for RA is cardiovascular disease, but the condition is also associated with heart attacks, strokes, as well as other specific cardiovascular issues, such as atherosclerosis, congestive heart failure, and peripheral vascular disease.

Why Preventing Heart Problems Is Crucial for People With RA

For these reasons, it is important for people living with rheumatoid arthritis to work with their doctors and healthcare providers to assess their heart disease risk factors, such as high blood pressure, smoking, and diabetes, and find ways to reduce them.

Discuss Statins With Your Doctor

Just because you have rheumatoid arthritis doesn’t mean you should automatically go on statins. The takeaway here is that if you have high cholesterol, discuss statins with your rheumatologist and internist.

https://www.everydayhealth.com/rheumatoid-arthritis/rheumatoid-arthritis-statins-are-safe-heart-protection/