Statins May Benefit Arthritis Patients With High CRP

NEW YORK — Patients with rheumatoid arthritis and elevated C-reactive protein levels may benefit from treatment with a statin to lower their CRP levels and consequently their risk for a cardiovascular event, regardless of their cholesterol levels, according to Dr. Jeffrey Greenberg.

This insight comes from a review of data from the 2008 JUPITER (Justification for the Use of Statins in Prevention: an Intervention Trial Evaluating Rosuvastatin) study of almost 18,000 people, all of whom had high-sensitivity CRP (hs-CRP) levels above 2 mg/L, but relatively normal LDL cholesterol levels of less than 130 mg/dL. They were randomized to either 20 mg rosuvastatin or placebo.

The trial planned to run 5 years; however, it was stopped after 2 years when the statin dropped LDL cholesterol levels by 50% on average, while CRP levels dropped by 37%. Of clinical note, the patients on the statin had significantly fewer episodes of nonfatal myocardial infarction, any MI, nonfatal stroke, and any stroke (N. Engl. J. Med. 2008;359:2195-207).

Although strictly speaking one might say that the findings from JUPITER cannot be extrapolated to rheumatoid arthritis patients, “clinical trials of this magnitude are rarely conducted in RA populations,” noted Dr. Greenberg. Rheumatologists need to extrapolate what they can from such large and potentially applicable trials, as well as from available and relevant observational studies.

Another compelling finding concerning the role of hs-CRP in increasing heart disease risk emerged after Dr. Greenberg's presentation: It was reported from the American College of Cardiology's annual meeting that JUPITER investigators doing subset analysis said that the effect of the statin on lowering the risk for cardiac events stemmed from its hs-CRP-lowering properties, rather than from its effect on cholesterol.

During his presentation, Dr. Greenberg, a rheumatologist at New York University Medical Center, reviewed an earlier trial's findings suggesting that statins can act like a disease-modifying antirheumatic drug in RA. TARA (Trial of Atorvastatin in Rheumatoid Arthritis) involved 116 patients, randomized to placebo or 40 mg atorvastatin for 6 months. All patients were on DMARD therapy and some were taking a corticosteroid. Use of a statin reduced all components of their disease activity score, including erythrocyte sedimentation rate, hs-CRP level, swollen joint count, and plasma viscosity. About 30% of patients had a 50% reduction in their CRP (Lancet 2004;363:2015-21).

Findings from recent studies suggest that RA patients are more likely than other patients with cardiovascular disease to have silent myocardial infarctions and sudden death (Arthritis Rheum. 2005;52:402-11). Another study found that RA patients who present with acute coronary syndrome may be more likely than other patients to have a second event and not to survive it (Ann. Rheum. Dis. 2006;65:348-53).

Given their patients' increased risk for CVD and its propensity for atypical presentation, rheumatologists must increase their vigilance to identify risk factors and intervene to lower them, he said.

NEW YORK — Patients with rheumatoid arthritis and elevated C-reactive protein levels may benefit from treatment with a statin to lower their CRP levels and consequently their risk for a cardiovascular event, regardless of their cholesterol levels, according to Dr. Jeffrey Greenberg.

This insight comes from a review of data from the 2008 JUPITER (Justification for the Use of Statins in Prevention: an Intervention Trial Evaluating Rosuvastatin) study of almost 18,000 people, all of whom had high-sensitivity CRP (hs-CRP) levels above 2 mg/L, but relatively normal LDL cholesterol levels of less than 130 mg/dL. They were randomized to either 20 mg rosuvastatin or placebo.

The trial planned to run 5 years; however, it was stopped after 2 years when the statin dropped LDL cholesterol levels by 50% on average, while CRP levels dropped by 37%. Of clinical note, the patients on the statin had significantly fewer episodes of nonfatal myocardial infarction, any MI, nonfatal stroke, and any stroke (N. Engl. J. Med. 2008;359:2195-207).

Although strictly speaking one might say that the findings from JUPITER cannot be extrapolated to rheumatoid arthritis patients, “clinical trials of this magnitude are rarely conducted in RA populations,” noted Dr. Greenberg. Rheumatologists need to extrapolate what they can from such large and potentially applicable trials, as well as from available and relevant observational studies.

Another compelling finding concerning the role of hs-CRP in increasing heart disease risk emerged after Dr. Greenberg's presentation: It was reported from the American College of Cardiology's annual meeting that JUPITER investigators doing subset analysis said that the effect of the statin on lowering the risk for cardiac events stemmed from its hs-CRP-lowering properties, rather than from its effect on cholesterol.

During his presentation, Dr. Greenberg, a rheumatologist at New York University Medical Center, reviewed an earlier trial's findings suggesting that statins can act like a disease-modifying antirheumatic drug in RA. TARA (Trial of Atorvastatin in Rheumatoid Arthritis) involved 116 patients, randomized to placebo or 40 mg atorvastatin for 6 months. All patients were on DMARD therapy and some were taking a corticosteroid. Use of a statin reduced all components of their disease activity score, including erythrocyte sedimentation rate, hs-CRP level, swollen joint count, and plasma viscosity. About 30% of patients had a 50% reduction in their CRP (Lancet 2004;363:2015-21).

Findings from recent studies suggest that RA patients are more likely than other patients with cardiovascular disease to have silent myocardial infarctions and sudden death (Arthritis Rheum. 2005;52:402-11). Another study found that RA patients who present with acute coronary syndrome may be more likely than other patients to have a second event and not to survive it (Ann. Rheum. Dis. 2006;65:348-53).

Given their patients' increased risk for CVD and its propensity for atypical presentation, rheumatologists must increase their vigilance to identify risk factors and intervene to lower them, he said.

NEW YORK — Patients with rheumatoid arthritis and elevated C-reactive protein levels may benefit from treatment with a statin to lower their CRP levels and consequently their risk for a cardiovascular event, regardless of their cholesterol levels, according to Dr. Jeffrey Greenberg.

This insight comes from a review of data from the 2008 JUPITER (Justification for the Use of Statins in Prevention: an Intervention Trial Evaluating Rosuvastatin) study of almost 18,000 people, all of whom had high-sensitivity CRP (hs-CRP) levels above 2 mg/L, but relatively normal LDL cholesterol levels of less than 130 mg/dL. They were randomized to either 20 mg rosuvastatin or placebo.

The trial planned to run 5 years; however, it was stopped after 2 years when the statin dropped LDL cholesterol levels by 50% on average, while CRP levels dropped by 37%. Of clinical note, the patients on the statin had significantly fewer episodes of nonfatal myocardial infarction, any MI, nonfatal stroke, and any stroke (N. Engl. J. Med. 2008;359:2195-207).

Although strictly speaking one might say that the findings from JUPITER cannot be extrapolated to rheumatoid arthritis patients, “clinical trials of this magnitude are rarely conducted in RA populations,” noted Dr. Greenberg. Rheumatologists need to extrapolate what they can from such large and potentially applicable trials, as well as from available and relevant observational studies.

Another compelling finding concerning the role of hs-CRP in increasing heart disease risk emerged after Dr. Greenberg's presentation: It was reported from the American College of Cardiology's annual meeting that JUPITER investigators doing subset analysis said that the effect of the statin on lowering the risk for cardiac events stemmed from its hs-CRP-lowering properties, rather than from its effect on cholesterol.

During his presentation, Dr. Greenberg, a rheumatologist at New York University Medical Center, reviewed an earlier trial's findings suggesting that statins can act like a disease-modifying antirheumatic drug in RA. TARA (Trial of Atorvastatin in Rheumatoid Arthritis) involved 116 patients, randomized to placebo or 40 mg atorvastatin for 6 months. All patients were on DMARD therapy and some were taking a corticosteroid. Use of a statin reduced all components of their disease activity score, including erythrocyte sedimentation rate, hs-CRP level, swollen joint count, and plasma viscosity. About 30% of patients had a 50% reduction in their CRP (Lancet 2004;363:2015-21).

Findings from recent studies suggest that RA patients are more likely than other patients with cardiovascular disease to have silent myocardial infarctions and sudden death (Arthritis Rheum. 2005;52:402-11). Another study found that RA patients who present with acute coronary syndrome may be more likely than other patients to have a second event and not to survive it (Ann. Rheum. Dis. 2006;65:348-53).

Given their patients' increased risk for CVD and its propensity for atypical presentation, rheumatologists must increase their vigilance to identify risk factors and intervene to lower them, he said.