Effect of intensive lipid-lowering therapy on cardiovascular outcome in patients with and those without inflammatory joint disease

Authors

  • Anne Grete Semb,

    Corresponding author
    1. Diakonhjemmet Hospital, Oslo, Norway
    • Department of Rheumatology, Diakonhjemmet Hospital, PO Box 23 Vinderen, NO-0319 Oslo, Norway
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    • Dr. Semb has received consulting fees, speaking fees, and/or honoraria from Merck/Schering-Plough, Abbott, Bristol-Myers Squibb, Wyeth/Pfizer, and Roche (less than $10,000 each).

  • Tore K. Kvien,

    1. Diakonhjemmet Hospital, Oslo, Norway
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    • Dr. Kvien has received consulting fees, speaking fees, and/or honoraria from Abbott, Bristol-Myers Squibb, MSD, Roche, and UCB (less than $10,000 each) and from Pfizer (more than $10,000) and research grants for Diakonhjemmet Hospital from Abbott, Bristol-Myers Squibb, MSD/Schering-Plough, Pfizer-Wyeth, Roche, and UCB.

  • David A. DeMicco,

    1. Pfizer, New York, New York
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    • Drs. DeMicco, Fayyad, and Wun own stock or stock options in Pfizer.

  • Rana Fayyad,

    1. Pfizer, New York, New York
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    • Drs. DeMicco, Fayyad, and Wun own stock or stock options in Pfizer.

  • Chuan-Chuan Wun,

    1. Pfizer, New York, New York
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    • Drs. DeMicco, Fayyad, and Wun own stock or stock options in Pfizer.

  • John C. LaRosa,

    1. State University of New York Health Science Center, Brooklyn
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    • Dr. LaRosa has received consulting fees, speaking fees, and/or honoraria from Pfizer and Amgen (less than $10,000 each).

  • John Betteridge,

    1. University College London Hospitals, London, UK
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    • Dr. Betteridge has received consulting fees, speaking fees, and/or honoraria from Takeda, MSD, Pfizer, Amgen, and AstraZeneca (less than $10,000 each).

  • Terje R. Pedersen,

    1. Oslo University Hospital, Ullevål, Oslo, Norway
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    • Dr. Pedersen has received consulting fees, speaking fees, and/or honoraria from Pfizer, Merck/Schering-Plough, and AstraZeneca (less than $10,000 each).

  • Ingar Holme

    1. Oslo University Hospital, Ullevål, Oslo, Norway
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    • Dr. Holme has received consulting fees, speaking fees, and/or honoraria from Pfizer, Merck/Schering-Plough, AstraZeneca, and Roche (less than $10,000 each).


  • ClinicalTrials.gov identifiers: NCT00159835 and NCT00327691.

Abstract

Objective

To examine the effect of intensive lipid-lowering therapy on a composite cardiovascular outcome (cardiovascular disease [CVD]), consisting of mortality and morbidity end points, in patients with inflammatory joint disease (rheumatoid arthritis [RA], ankylosing spondylitis [AS], or psoriatic arthritis [PsA]) by post hoc analysis of 2 prospective trials of statins with a secondary end point of CVD outcome (the Treating to New Targets [TNT] and Incremental Decrease in End Points Through Aggressive Lipid Lowering [IDEAL] studies).

Methods

Of the 18,889 patients participating in the 2 trials, 199 had RA, 46 had AS, and 35 had PsA. Lipid-lowering therapy consisted of an intensive regimen of atorvastatin 80 mg or a conventional/low-dose regimen of atorvastatin 10 mg or simvastatin 20–40 mg. The median duration of followup was nearly 5 years. Changes in lipid levels were examined by analyses of covariance. The effect on CVD was examined by Cox regression analyses, and heterogeneity tests were performed.

Results

Patients with RA and those with AS had lower baseline cholesterol levels than patients without inflammatory joint disease (least squares mean ± SEM 180.7 ± 2.3 mg/dl and 176.5 ± 4.7 mg/dl, respectively, versus 185.6 ± 0.2 mg/dl; P = 0.03 and P = 0.05, respectively). Statin treatment led to a comparable decrease in lipid levels and a 20% reduction in overall risk of CVD in both patients with and those without inflammatory joint disease.

Conclusion

Our findings indicate that patients with and those without inflammatory joint disease experience comparable lipid-lowering effects and CVD risk reduction after intensive treatment with statins.

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