Can statins save the lives of rheumatoid arthritis patients? asks new clinical trial
More than 3,500 people with rheumatoid arthritis are to take part in a major new clinical trial to find out if taking statins reduces the number of patients who die from arthritis-related heart attacks and strokes.
Rheumatoid arthritis patients have an increased risk of dying from cardio-vascular complications compared to the general population, but few are routinely prescribed the cholesterol-lowering drugs, statins.
Now a new five-year £1.1m multi-centre trial, funded jointly by two leading medical research charities, the Arthritis Research Campaign and the British Heart Foundation, aims to find out if taking a statin daily reduces this risk.
Doctors running the trial, which starts recruiting later this year, said that if, as expected, statins were shown to be effective in reducing cardio-vascular deaths in rheumatoid arthritis, most patients with this condition should be put on the drugs as a matter of course.
Dr George Kitas, trial chief investigator and a consultant rheumatologist at Russell’s Hall Hospital in Dudley, West Midlands, said: “It has been known for some time that there is a link between rheumatoid arthritis and cardio-vascular mortality. This may be in large part due to early and more advanced blood vessel damage due to high levels of inflammation in RA. Statins lead to a reduction of cardiovascular death rates by reducing cholesterol and possibly inflammation.
“If this trial works as expected, we could be looking at a reduction of the absolute risk of cardiovascular death rate in RA patients by ten to 15 per cent, or the relative risk by 35 to 40 per cent, which is significant.”
Statins have been routinely given to people who have had heart attacks to lower the risk of them suffering a second for the past few years. This week new guidelines from the National Institute for Health and Clinical Excellence (NICE) extended the use of the drugs to an extra three million people with a 20 per cent risk over ten years of developing cardiovascular disease, which can lead to heart attack, angina and stroke.
Over the next 18 months more than 40 rheumatology departments around the UK will be involved in recruiting on average 100 RA patients over the age of 40 with a less than 20 per cent risk of developing cardiovascular disease onto the trial. (Patients with a higher risk should be prescribed statins as per NICE guidance.) They will be given either a statin or a placebo, in addition to any other treatment they require for their arthritis, and will all receive advice on how to reduce the risk of heart disease by exercising, eating healthily and stopping smoking.
Annual cardio-vascular risk assessment in RA patients has been included in new Standards of Care guidelines produced by ARMA, an umbrella body of arthritis organisations and charities, as desirable, but is not routinely performed in all hospitals.
Another knock-on effect of the trial would be a greater awareness of the cardiovascular complications of RA, and a greater emphasis on patients changing their lifestyles to reduce the risks. “One of the problems is that many patients with high cholesterol and blood vessel damage are unaware of it until they have a heart attack or stroke,” added Dr Kitas.
