Statins for prevention of cardiovascular disease in systemic lupus erythematosus

Objective: In systemic lupus erythematosus (SLE), cardiovascular disease (CVD) is an important cause of long-term morbidity, which could be affected by statin use. Here we review the evidence for the use of statins for the prevention of CVD in patients with SLE. Methods: The PubMed database was searched using a query combining SLE and statins. Results: The search yielded nine relevant clinical studies. Seven studies reported on radiological findings that correlate with atherosclerosis and mainly revealed that statin treatment resulted in a slight decrease in progression of carotid intima-media thickness and an increase in flow-mediated vasodilatation. Two studies investigated CVD and mortality. In a group of SLE patients that had received a kidney transplantation, three of 23 statin-treated SLE patients experienced cardiac events compared with four of ten placebo-treated controls. Moreover, in a retrospectively studied cohort of SLE patients with dyslipidaemia, statin treatment in 777 patients was associated with a large decrease in coronary heart disease (hazard ratio [HR] = 0.20), cerebrovascular disease (HR = 0.14), end-stage renal disease (HR = 0.22) and mortality (HR = 0.44) compared with 1317 patients that had not been prescribed statins. However, the latter retrospective study was subject to bias and causality can only be proven in a randomised trial. Statins showed a good safety profile in SLE patients. Conclusion: Whilst awaiting new prospective randomised studies, we recommend prescription of statins in SLE patients with increased cardiovascular risk according to the current recommendations for cardiovascular risk management in rheumatoid arthritis.