Clinical Edge

Summaries of Must-Read Clinical Literature, Guidelines, and FDA Actions

Atorvastatin May Lower Cardiovascular Risk in RA patients

Key clinical point: RA patients saw a reduced risk of cardiovascular events after adding statins to their treatment.

Major finding: Patients who received atorvastatin had 0.77 plus/minus 0.04 mmol/L lower LDL-cholesterol, compared with patients who received placebo (P less than .0001).

Study details: A multicenter, randomized, double-blind study of 3,002 patients with RA who were treated with either atorvastatin or placebo.

Disclosures: The study was funded by Arthritis Research UK and the British Heart Foundation. The coauthors report numerous potential conflicts of interest, including receiving honoraria for lectures and advisory board participation, grant support, and consulting fees from various pharmaceutical companies.


Kitas GD et al. Arthritis Rheumatol. 2019 Apr 15. doi: 10.1002/art.40892.


Although it did not accomplish exactly what it set out to do, the TRACE RA study is a firm step in the right direction, according to Katherine P. Liao, MD, and Daniel H. Solomon, MD, of Brigham and Women’s Hospital in Boston.

To illustrate their point, Dr. Liao and Dr. Solomon presented a hypothetical RA patient called TR. She is firmly “average,” especially among the population represented in this study. Though she doesn’t seem like a glaring candidate for a statin, we can rightfully assume that – because of RA and a C-reactive protein above 2 mg/dL – her cardiovascular risk is higher than a member of the general population. The next step is determining if a statin will benefit such a patient, something relatively unexplored thus far.

Despite its abrupt termination, the coauthors “laud the investigators of TRACE RA, as this is the first trial among RA patients that was designed to study hard CVD endpoints.” At the very least, the study reinforced that statins are not associated with side effects when paired with typical RA treatments. In the future, Dr. Liao and Dr. Solomon suggested a focus on “better methods for identifying the appropriate patient population in RA to target for CV risk reduction strategies.”

These comments are adapted from an accompanying editorial (Arthritis Rheumatol. 2019 Apr 15. doi: 10.1002/art.40891). Dr. Solomon reported receiving salary support through research contracts from AbbVie, Amgen, Corrona, Genentech, Janssen, and Pfizer.