Background/Purpose:  Patients with ankylosing spondylitis (AS) have increased risk of cardiovascular disease (CVD). In the general population, CVD risk reduction can be achieved by lipid lowering therapy (LLT). We aimed to evaluate the effect of statins in AS patients and factors associated with the changes (Δ) in low-density lipoprotein cholesterol (LDL-c) and total cholesterol (TC).

Methods: In this longitudinal, observational study, 108 patients with AS underwent CVD risk evaluation. Of these, 48 patients had an indication for LLT and received statin treatment which was adjusted until lipid targets were achieved. Variables obtaining a p-value of < 0.25 in a univariate analyses were entered in forward, stepwise, linear regression models with ΔLDL-c and ΔTC as the dependent variables and were adjusted for age and gender, as well as baseline LDL-c levels (for ΔLDL-c) and intensity of LLT (for ΔTC).

Results: At first visit, median (IQR) age was 61.5 (56.0, 66.8) years, 72.9 % were male, median disease duration was 27 (17.8, 32.8) years, 12.5 % smoked daily, 70.8 % had hypertension (HT), mean (SD) body mass index (BMI) was 26.0 (3.50) kg/m², mean LDL-c and TC, were 3.82±1.02 and 6.04±1.16mmol/L and 70.8 % had carotid plaque(s). Twenty patients were treated with low or moderate intensity LLT (simvastatin 20 mg or 40 mg, rosuvastatin <40 mg or atorvastatin <40 mg), while the remaining 28 received intensive LLT (rosuvastatin 40 mg or atorvastatin >40 mg). LDL-c goals (50% reduction in LDL-c and /or LDL-c <2.5 /<1.8 mmol/L, for primary (n=10) or secondary prevention (n=38), respectively) were achieved in 85.4% of patients (90.0% and 84.2% for primary and secondary prevention, respectively). Reductions in LDL-c and TC were 1.60+0.41 mmol/L and 2.42+1.15 mmol/L (p<0.001 for both). Predictive variables explaining 86.5% (R²) of the ΔLDL-c included erythrocyte sedimentation rate (ESR), established CVD and HT. Only ESR (p=0.03) and baseline LDL-c (p<0.001) contributed significantly to the final model. ESR was inversely related to ΔLDL-c. In addition, higher baseline LDL-c levels were associated with larger LDL-c reduction. The final model for ΔTC, accounting for 33.0% (R²) of the variation, included ESR, waist circumference, BMI, non-steroidal anti-inflammatory drugs, and use of biologic and synthetic disease modifying anti-rheumatic drugs. Intensive LLT and high waist circumference were predictive of greater TC reductions (p=0.002 and 0.04, respectively).

Conclusion: Lipid lowering with statins was highly effective in AS patients. Inflammation measured by ESR was inversely related to change in LDL-c, possibly due to the suppressive effect on lipid levels. Further studies are needed to elucidate if the anti-inflammatory effect of rheumatic medication influence the lipid lowering effect of statins in patients with AS.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/statin-treatment-in-patients-with-ankylosing-spondylitis/