Therapeutic impact of statins on the lipid profile and cardiovascular risk in patients with rheumatoid arthritis: Systematic review of the literature and a meta-analysis

Context: Patients with rheumatoid arthritis have a higher cardiovascular risk due to the prevalence of cardiovascular risk factors and metabolic alterations derived from the inflammatory activity and the treatment of their disease. A systematic evaluation of the effect of statins on lipid fractions and cardiovascular outcomes has not been carried out specifically in patients with rheumatoid arthritis. Methods: A literature search was conducted in Medline (PubMed), Embase, Lilacs, Scielo, and Cochrane. Randomized and non-randomized clinical trials were selected that evaluated the impact of statins on mortality, cardiovascular events, lipid fractions and disease activity in patients with rheumatoid arthritis. A paired evaluation of risk of bias was carried out, along with a meta-analysis using RevMan 5.3®. Results: A total of 5 studies and 383 patients were included in the analysis. The use of statins among patients with rheumatoid arthritis significantly reduced total cholesterol levels: −46.16 mg/dL (95% CI: [−53.89, −38.46]; I ² : 86%), LDLc: −18.13 mg/dL (95% CI: [−21.8, −14.4], I ² : 97%) and TG of −34.95 mg/dL (95% CI: [−44.3, −25.6], I ² : 0%), without significant changes in HDLc. It also reduced the activity of the disease (DAS28) by 0.73 (95% CI: [−0.94, −0.53], I ² : 96%). No study was found that reported mortality or cardiovascular outcomes. Conclusion: The lipid-lowering effect of statins in patients with rheumatoid arthritis is consistent with that found in other populations. There is a slight impact in reducing the activity of the disease, but reducing the risk of cardiovascular events in this specific population has not been studied.