{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,3]],"date-time":"2026-11-03T06:12:41Z","timestamp":1793686361710,"version":"4.5.1"},"reference-count":47,"publisher":"Wiley","issue":"9","license":[{"start":{"date-parts":[[2019,7,22]],"date-time":"2019-07-22T00:00:00Z","timestamp":1563753600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100000341","name":"Arthritis Research UK","doi-asserted-by":"publisher","award":["16514"],"award-info":[{"award-number":["16514"]}],"id":[{"id":"10.13039\/501100000341","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100000341","name":"Arthritis Research UK","doi-asserted-by":"publisher","award":["19704"],"award-info":[{"award-number":["19704"]}],"id":[{"id":"10.13039\/501100000341","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100000274","name":"British Heart Foundation","doi-asserted-by":"publisher","award":["SP\/06\/001"],"award-info":[{"award-number":["SP\/06\/001"]}],"id":[{"id":"10.13039\/501100000274","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["acrjournals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Arthritis & Rheumatology"],"published-print":{"date-parts":[[2019,9]]},"abstract":"Objective<\/jats:title>Rheumatoid arthritis (RA<\/jats:styled-content>) is associated with increased cardiovascular event (CVE<\/jats:styled-content>) risk. The impact of statins in RA<\/jats:styled-content> is not established. We assessed whether atorvastatin is superior to placebo for the primary prevention of CVE<\/jats:styled-content>s in RA<\/jats:styled-content> patients.<\/jats:p><\/jats:sec>Methods<\/jats:title>A randomized, double\u2010blind, placebo\u2010controlled trial was designed to detect a 32% CVE<\/jats:styled-content> risk reduction based on an estimated 1.6% per annum event rate with 80% power at P<\/jats:italic> < 0.05. RA<\/jats:styled-content> patients age >50 years or with a disease duration of >10 years who did not have clinical atherosclerosis, diabetes, or myopathy received atorvastatin 40 mg daily or matching placebo. The primary end point was a composite of cardiovascular death, myocardial infarction, stroke, transient ischemic attack, or any arterial revascularization. Secondary and tertiary end points included plasma lipids and safety.<\/jats:p><\/jats:sec>Results<\/jats:title>A total of 3,002 patients (mean age 61 years; 74% female) were followed up for a median of 2.51 years (interquartile range [IQR<\/jats:styled-content>] 1.90, 3.49 years) (7,827 patient\u2010years). The study was terminated early due to a lower than expected event rate (0.70% per annum). Of the 1,504 patients receiving atorvastatin, 24 (1.6%) experienced a primary end point, compared with 36 (2.4%) of the 1,498 receiving placebo (hazard ratio [HR<\/jats:styled-content>] 0.66 [95% confidence interval (95% CI<\/jats:styled-content>) 0.39, 1.11]; P<\/jats:italic> = 0.115 and adjusted HR<\/jats:styled-content> 0.60 [95% CI<\/jats:styled-content> 0.32, 1.15]; P<\/jats:italic> = 0.127). At trial end, patients receiving atorvastatin had a mean \u00b1 SD<\/jats:styled-content> low\u2010density lipoprotein (LDL<\/jats:styled-content>) cholesterol level 0.77 \u00b1 0.04 mmoles\/liter lower than those receiving placebo (P<\/jats:italic> < 0.0001). C\u2010reactive protein level was also significantly lower in the atorvastatin group than the placebo group (median 2.59 mg\/liter [IQR<\/jats:styled-content> 0.94, 6.08] versus 3.60 mg\/liter [IQR<\/jats:styled-content> 1.47, 7.49]; P<\/jats:italic> < 0.0001). CVE<\/jats:styled-content> risk reduction per mmole\/liter reduction in LDL<\/jats:styled-content> cholesterol was 42% (95% CI<\/jats:styled-content> \u221214%, 70%). The rates of adverse events in the atorvastatin group (n = 298 [19.8%]) and placebo group (n = 292 [19.5%]) were similar.<\/jats:p><\/jats:sec>Conclusion<\/jats:title>Atorvastatin 40 mg daily is safe and results in a significantly greater reduction of LDL<\/jats:styled-content> cholesterol level than placebo in patients with RA<\/jats:styled-content>. The 34% CVE<\/jats:styled-content> risk reduction is consistent with the Cholesterol Treatment Trialists\u2019 Collaboration meta\u2010analysis of statin effects in other populations.<\/jats:p><\/jats:sec>","DOI":"10.1002\/art.40892","type":"journal-article","created":{"date-parts":[[2019,4,15]],"date-time":"2019-04-15T05:06:10Z","timestamp":1555304770000},"page":"1437-1449","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":117,"title":["A Multicenter, Randomized, Placebo\u2010Controlled Trial of Atorvastatin for the Primary Prevention of Cardiovascular Events in Patients With Rheumatoid Arthritis"],"prefix":"10.1002","volume":"71","author":[{"given":"George D.","family":"Kitas","sequence":"first","affiliation":[{"name":"Dudley Group NHS Foundation Trust, Russells Hall Hospital, Stourbridge, UK and Research UK Centre for Epidemiology Manchester UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter","family":"Nightingale","sequence":"additional","affiliation":[{"name":"University of Birmingham Birmingham UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jane","family":"Armitage","sequence":"additional","affiliation":[{"name":"University of Oxford Oxford UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Naveed","family":"Sattar","sequence":"additional","affiliation":[{"name":"University of Glasgow, Glasgow, UK and Oxford Centre for Diabetes, Endocrinology and Metabolism Oxford UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jill J. 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