Patients with rheumatoid arthritis and carotid artery plaques have increased risk of acute coronary syndromes. Statin treatment with low density lipoprotein cholesterol ( LDL-c ) goal less than or equal to 1.8 mmol/L ( less than or equal to 70mg/dl ) is recommended for patients with carotid artery plaques in the general population.
In the RORA-AS ( ROsuvastatin in Rheumatoid Arthritis, Ankylosing Spondylitis and other inflammatory joint diseases ) trial, the aim was to evaluate the effect of 18 months intensive lipid lowering with Rosuvastatin ( Crestor ) with regard to change in carotid artery plaques height.
Eighty-six patients ( 60.5% female ) with carotid artery plaques and inflammatory joint disease [ rheumatoid arthritis ( n=55 ), ankylosing spondylitis ( n=21 ) and psoriatic arthritis ( n=10 ) ] were treated with Rosuvastatin to obtain LDL cholesterol goal.
Carotid artery plaques height was evaluated by B-mode ultrasound.
The mean±SD age was 60.8±8.5 years, and the median compliance of Rosuvastatin use was 97.9% ( IQR 96.0, 99.4 ). At baseline, the median number and height of the carotid artery plaques was 1.0 ( range 1-8 ) and 1.80mm ( IQR 1.60, 2.10 ), respectively.
Change in carotid artery plaques height after 18 months rosuvastatin treatment was -0.19±0.35mm ( p less than 0.001 ).
Baseline level and change in LDL cholesterol was 4.0±0.9 mmol/L ( 154.68±34.80mg/dl ) and -2.3±0.8 mmol/L ( 88.94±30.94mg/dl ) ( p less than 0.001 ).
Mean LDL cholesterol level during the 18 months of Rosuvastatin treatment was 1.7±0.4 mmol/L ( area under the curve ) ( 65.74±15.47mg/dl ).
There was no linear relationship between carotid artery plaques height reduction and LDL cholesterol exposure during the study period ( p=0.36 ) ( adjusted for age / gender/blood pressure ).
Attainment of the LDL cholesterol goal less than or equal to 1.8 mmol/L ( less than or equal to 70 mg/dl ) or the amount of change in LDL cholesterol during the study period did not influence the degree of carotid artery plaques height reduction ( p=0.44 and p=0.46 ).
In conclusion, intensive lipid lowering with Rosuvastatin induced atherosclerotic regression and reduced LDL cholesterol significantly in patients with inflammatory joint disease. ( Xagena )
Rollefstad S et al, Arthritis Rheumatol 2015; Epub ahead of print