TOPIC SERIES: CVD PREVENTION IN RHEUMATIC DISEASE

Arterial stiffness and blood pressure were both reduced in patients with inflammatory joint disease and comorbid atherosclerotic cardiovascular disease (ASCVD) treated with rosuvastatin, according to research published in Plos One. 

Inflammatory joint diseases, including rheumatoid arthritis (RA), ankylosing spondylitis (AS), and psoriatic arthritis (PsA) are associated with increased arterial stiffness and blood pressure (BP). Prior studies have shown that short-term treatment with simvastatin and atorvastatin reduced the measured augmentation index (AIx) and aortic pulse wave velocity (aPWV) in patients with RA.  


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To investigate whether long-term statin treatment results in sustained reductions in arterial stiffness, Eirik Ikdahl, MD, from Diakonjemmet Hospital, Oslo, Norway, and colleagues examined the effects of 18 months of rosuvustatin treatment on patients with RA, PsA, or AS (ClinicalTrials.gov Identifier NCT01389388).

A total of 89 patients with inflammatory joint disease who also had evidence of carotid atherosclerotic plaques were treated with rosuvastatin for 18 months to reach a low-density lipoprotein (LDL) cholesterol goal of ≤1.8 mmol/L.

After 18 months of treatment,  AIxs, aPWVs, and BP were measured in study participants. The researchers found that AIx, aPWV, systolic and diastolic BP were all reduced at the end of the study period as compared to baseline.  

When compared to baseline, changes in measured parameter means  (95% confidence interval [CI]) were:  ΔAIx: -0.34 (-0.03,-0.65)% (=.03) ; ΔaPWV: -1.69 (-0.21,-3.17) m/s(=.03) ; Δ systolic BP: -5.27 (-1.61,-8.93) mmHg (=.004), and Δ diastolic BP -2.93 (-0.86,-5.00) mmHg (P=.01).

Summary and Clinical Applicability

Patients with inflammatory joint disease treated with rosuvustatin for 18 months had measurable decreases in arterial stiffness and blood pressure. 

“The improvement of aPWV and reduction in BP levels were correlated; this may provide novel insight into the mechanisms responsible for the pleiotropic effects by statins”, the authors concluded. 

Limitations and Disclosures

This study was not designed to address effects of escalating doses of rosuvustatin, including adverse drug effects. The LDL “treat to target” goal may not be broadly applicable to all patients. Additionally, the clinical implications of these degrees of reduced arterial stiffness and blood pressure on long-term morbidity and mortality have to be evaluated in cohorts of patients with RA.

This study was funded by The South Eastern Norway Regional Health Authority.

Reference

Ikdahl E, Rollefstad S, Hisdal J, et al. Sustained Improvement of Arterial Stiffness and Blood Pressure after Long-Term Rosuvastatin Treatment in Patients with Inflammatory Joint Diseases: Results from the RORA-AS Study. PLoS ONE. 2016;11(4):e0153440.