Influence of atorvastatin on coronary calcifications and myocardial perfusion defects in systemic lupus erythematosus patients: a prospective, randomized, double-masked, placebo-controlled study

Abstract

IntroductionMortality in systemic lupus erythematosus (SLE) patients is influenced by an increased occurrence of severe cardiovascular complications. Statins have been proven to protect a wide spectrum of SLE patients from these complications. This study was conducted to determine the possible efficacy of atorvastatin in SLE patients as assessed by multi-detector computed tomography (MDCT)-based coronary calcium scoring and single photon emission computed tomography (SPECT) of the myocardium.MethodsSixty SLE patients in stable clinical conditions were randomized to receive either atorvastatin (40 mg daily; n = 28) or placebo (n = 32). Clinical and biochemical evaluation together with MDCT-based coronary calcium scoring and SPECT studies (Tc-99 m sestamibi) were performed at the time of randomization and after 1 year of treatment.ResultsAt randomization, SPECT revealed perfusion defects at rest in 22 (36.7%) patients and exercise-induced defects in 8 (13.3%), whereas MDCT revealed coronary calcifications in 15 subjects (25%). Coronary calcium deposits increased after 1 year in the placebo group (plaque volume change from 35.2 ± 44.9 to 62.9 ± 72.4, P < 0.05; calcium score from 32.1 ± 39.1 to 59.5 ± 64.4; P < 0.05), but not in the atorvastatin group (plaque volume 54.5 ± 62.4 vs. 51.0 ± 47.6, P not significant; calcium score 44.8 ± 50.6 vs. 54.9 ± 62.5, P not significant). The atorvastatin group showed a decrease in total serum cholesterol (from 5.1 ± 1.2 to 4.4 ± 0.7 mmol/L, P < 0.05), LDL cholesterol (2.9 ± 1.0 to 2.3 ± 0.6 mmol/L, P < 0.05), triglycerides (1.6 ± 0.6 to 1.2 ± 0.5 mmol/L, P < 0.05), and C-reactive protein (CRP) (4.4 ± 4.1 to 2.7 ± 1.7 mg/L, P < 0.05). There was no change in the mean Systemic Lupus Erythematosus Disease Activity Index (SLEDAI) score in patients from both groups. Perfusion defects observed at randomization showed no change after one year treatment with atorvastatin.ConclusionsIn SLE patients 40 mg of atorvastatin daily for 1 year led to a decrease in serum lipids and CRP levels. Additionally the progression of atherosclerosis, as assessed by MDCT-based coronary calcium scoring, is restrained by atorvastatin treatment. The value of statin treatment in patients with SLE free from cardiovascular disease clinical symptoms should be addressed in large, prospective clinical trials.

Statin-induced lupus: a case/non-case study in a nationwide pharmacovigilance database

“…At one year, atorvastatin significantly decreased coronary calcification progression (but not myocardial perfusion), lipids and C-reactive protein levels in the first trial. 3 At two years, the benefit of atorvastatin on carotid intima-media thickness was statistically significant in a post-hoc analysis of the second trial. 4 In both studies, there was no change of the SLEDAI score on atorvastatin, but the trials were not designed to assess disease flare prevention.…”

Does Renin‐Angiotensin System Blockade Protect Lupus Nephritis Patients From Atherosclerotic Cardiovascular Events? A Case–Control Study

“…Certain therapeutic 9 approaches, usually with statins, have been implemented for halting subclinical atherosclerosis in lupus patients with inconsistent results [12][13][14][15]. Other preventive strategies, such as ACEIs and ARBs, which have shown a significant benefit in at-risk populations [5], have not been tested in SLE patients.…”

The social and health gender differences in patients companion in the family medicine consultation

“…We found that companion female had more diseases of the musculoskeletal system and connective tissue (44% vs. 21% in male companions; p=0.024), and they were taking more medications of the musculoskeletal system (26.2% vs. 5.4% in male companions; p=0.014), but we found no difference in diseases or treatments about mental health (Table 1). Other authors have also noted that women caregivers reported significantly more physically unhealthy days than men, and more physical morbidity (lower physical health scores, poorer physical functioning, and loss of physical strength) (29,30).…”