Background/Purpose: Dyslipidemia in patients with rheumatoid arthritis (RA) is well recognized. The impact of lipid-lowering medications on lipid levels in patients with RA vs non-RA subjects has not been comprehensively studied in large population-based cohorts. We aimed to examine lipid profiles among statin naive patients with RA and those without RA before and after the initiation of statins.

Methods:

Lipid measures were abstracted in a population-based incident cohort of RA patients (1987 ACR criteria first met between 1/1/1988 and 1/1/2008) and in a cohort of non-RA subjects from the same underlying population. Information regarding statin use was gathered in both cohorts. Only patients with no history of statin use who started a statin for dyslipidemia between 1 year prior to RA diagnosis/index date and last follow-up were included. Target lipid levels for both cohorts were defined as follows: total cholesterol (TC) <200 mg/dL, low density lipoprotein cholesterol (LDL) <160 mg/dL, triglycerides <150 mg/dL, high density lipoprotein cholesterol (HDL) ≥50 mg/dL. T-tests and linear regression models were used to compare changes in lipid profiles between the RA and non-RA cohorts.

Results: The study included a cohort of 161 patients with RA (mean age 56.3 years, 57% female, 66% rheumatoid factor positive) and 221 non-RA subjects (mean age 56.0 years, 66% female). Prior to the start of statins, the levels of TC (mean+/-standard deviation, 225.3+/-54.7 mg/dL) and LDL (141.0+/-53.4 mg/dL) in the RA cohort were significantly lower than in the non-RA cohort (TC: 242.3+/-45.8 mg/dL, p<0.001, and LDL: 155.2+/-40.6 mg/dL, p=0.004). The decrease in absolute LDL values after at least 90 days of statin use was less pronounced in the RA vs non-RA cohort (-33.7+/-42.8 mg/dL vs -44.7+/-38.5 mg/dL, respectively, p=0.025); a similar trend was observed for TC (-35.6+/-46.3 mg/dL vs -43.5+/-41.4 mg/dL, p=0.08). There were no significant differences in baseline and/or follow-up levels of triglycerides, HDL, and TC/HDL in RA vs non-RA cohorts. During the 90-day follow-up, the percentage change in LDL, but not in other lipids, was significantly smaller (by 9%) in RA than in the non-RA cohort (p=0.039), adjusting for age, sex, smoking, diabetes mellitus, hypertension, and coronary heart disease. However, RA patients with altered lipid levels were as likely to reach lipid targets with statin use as non-RA subjects (all p > 0.05). A total of 89% of RA vs 91% of non-RA subjects met the target levels for LDL after 90 days of statin use (p=0.53). There were no apparent changes in the use of disease-modifying antirheumatic drugs and biologics in RA patients during the study period.

Conclusion: Before statin initiation, patients with RA had significantly lower TC and LDL levels than non-RA subjects. Absolute and relative decreases in LDL values following statin initiation were smaller in RA than in non-RA subjects. Nonetheless, patients with RA were as likely to achieve conventional lipid goals as non-RA subjects suggesting the potential for clinical benefits of statins in RA. More studies are needed to determine the impact of improvement in lipid profile with statin use on cardiovascular risk reduction in RA.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/the-impact-of-statin-use-on-lipid-levels-in-statin-naive-patients-with-rheumatoid-arthritis-ra-vs-non-ra-subjects-results-from-a-population-based-study/