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Original Article
DOI: 10.1016/j.reumae.2017.12.005
Available online 4 May 2019
Therapeutic impact of statins on the lipid profile and cardiovascular risk in patients with systemic lupus erythematosus: Systematic review of the literature and a meta-analysis
Impacto terapéutico de las estatinas en el perfil lipídico y el riesgo cardiovascular en pacientes con lupus eritematoso sistémico: revisión sistemática de la literatura y metaanálisis
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Paula Sáncheza,
Corresponding author
paulasanchez@javeriana.edu.co

Corresponding author.
, Esteban Toro-Trujilloa, Oscar M. Muñoz-Velandiab, Angel Alberto Garcíac, Daniel G. Fernández-Ávilad
a Departamento de Medicina Interna, Facultad de Medicina, Pontificia Universidad Javeriana, Bogotá, Colombia
b Departamento de Medicina Interna, Hospital Universitario San Ignacio, Pontificia Universidad Javeriana, Bogotá, Colombia
c Departamento de Medicina Interna, Unidad de Cardiología, Hospital Universitario San Ignacio, Pontificia Universidad Javeriana, Bogotá, Colombia
d Departamento de Medicina Interna, Unidad de Reumatología, Hospital Universitario San Ignacio, Pontificia Universidad Javeriana, Bogotá, Colombia
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Table 1. Studies included.
Table 2. Quality of the studies.
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Abstract
Background

There is strong evidence of a rise in cardiovascular risk in patients suffering from autoimmune diseases, especially in those with Systemic Lupus Erythematosus. Until now, there are a few trials that assess the potencial benefit of statins on the incidence of cardiovascular events and on lipid profile of patients with SLE. This evidence has not been synthesised and assessed altogether.

Methods

We performed a search in databases of literature published until August of 2016 (Embase, MEDLINE, Cochrane Library, SciELO, Clinical Evidence, DynaMed, Cochrane Central Register of Controlled Trials, LILACS), identifying controlled clinical trials that could estimate the impact of statins on mortality, cardiovascular events, C-reactive protein and lipid profile in patients with Systemic Lupus Erythematosus. The quality of the information available was assessed with a meta-analysis, using a random effects model, employing the RevMan 5.3 software.

Results

6 trials and 412 patients were included in the analysis. The use of statins in patients with SLE was found to significantly reduce the levels of serum total cholesterol (mean difference [MD] −31.4mg/dL; CI 95% −43.0; −19.9), and serum low density cholesterol (MD −31.4mg/dL; IC 95% −43.0; −19.9), but had no impact on levels of serum triglycerides (MD 4mg/dL; IC 95% 2.49; 6.21) and C-reactive protein (MD −0.78; IC 95% −1.43; −0.13). No evidence was found about the impact on the risk of mortality or cardiovascular events.

Conclusion

Statins have a significant effect on the levels of serum total cholesterol, LDL cholesterol and C-reactive protein, however, more randomised controlled trials with long-term follow-up are necessary to assess the impact on mortality and cardiovascular risk.

Keywords:
Lipids
Systemic lupus erythematosus
Statins
Resumen
Antecedentes

Existe evidencia que muestra un aumento del riesgo cardiovascular en pacientes que padecen de enfermedades autoinmunes, en particular, de lupus eritematoso sistémico. Hasta el momento existen pocos estudios que evalúen el potencial beneficio de las estatinas en la incidencia de eventos cardiovasculares y en el perfil lipídico de pacientes con, y esta evidencia no ha sido sintetizada y evaluada en conjunto.

Métodos

Se realizó una búsqueda de la literatura hasta agosto de 2016 (Embase, MEDLINE, Cochrane Library, SciELO, Clinical Evidence, DynaMed, registro de experimentos clínicos de Cochrane, LILACS), identificando ensayos clínicos controlados que evaluaran el impacto de las estatinas en mortalidad, eventos cardiovasculares, proteína C reactiva y perfil lipídico en pacientes con lupus eritematoso sistémico. Se evaluó la calidad de la información disponible y se metaanalizó utilizando un modelo de efectos aleatorios, utilizando el programa RevMan 5.3.

Resultados

Un total de 6 estudios y 412 pacientes fueron incluidos para el análisis. Se encontró que el uso de las estatinas en paciente con LES reduce significativamente los niveles de colesterol total (diferencia de medias [DM] −31,2mg/dL; IC 95% −41,9; −20,5), colesterol de baja densidad (DM −31,4mg/dL; IC 95% −43,0; −19,9), sin impacto en los niveles de triglicéridos (DM 4mg/dL; IC 95% 2,49; 6,21) y proteína C reactiva (DM −0,78; IC 95% −1,43; −0,13). No se encontró ninguna evidencia sobre impacto en el riesgo de mortalidad o eventos cardiovasculares.

Conclusión

Las estatinas tienen un impacto significativo en los niveles de colesterol total, colesterol unido a lipoproteínas de baja densidad y proteína C reactiva, sin embargo, son necesarios nuevos estudios aleatorizados controlados con seguimiento a largo plazo para evaluar el impacto en la mortalidad y el riesgo cardiovascular.

Palabras clave:
Lípidos
Lupus eritematoso sistémico
Estatinas

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