Effects of statins on serum lipids, disease activity, C-reactive protein and carotid intima-media thickness in systemic lupus erythematosus patients: a systemic review and mata-analysis

Xiaohuan Chen¹, Jiacheng Shi¹, Lei Liu¹, Lei Liao¹, Yahui Wang¹, Hanyou Mo^2*

¹Guilin Medical University, Guangxi, China - ²Department of rheumatology, the Affiliated Hospital of Guilin University, Guangxi, China

Introduction: Cardiovascular disease presents an early and high rate trend in patients with systemic lupus erythematosus(SLE). Statins not only have excellent lipid-lowering effects, but also have anti-inflammatory and immune-regulating effects. Whether statins can affect serum lipids, disease activity, C-reactive protein (CRP) and carotid intima-media thickness (CIMT) in SLE patients is unclear, so we conducted a systematic review and meta-analysis to address this issue.

Case presentation: Literatures were obtained by searching Pubmed, Embase, Medline and Cochrane Databases as of 29 February 2020. Stata software (ver.15.0) was used for data analysis. We calculated the difference between baseline and follow-up data for each group, then analyzed and compared them. We used the random-effects model and standard mean difference (SMD) and its 95% confidence interval (CI) for meta-analysis. The I2 index was used to evaluate the heterogeneity. In the presence of high heterogeneity, sensitivity analysis and subgroup analysis were performed. In total, 6 studies met our inclusion criteria, including 5 randomized, double-blind, placebo-controlled studies and 1 controlled trail. A total of 535 subjects were included in the study. Of which 284 were in the statin group and 251 were in the control group. Compared with the control group, TC [-1.329(-1.928,-0.731), P<0.001; I2=85.8%, P<0.001] and LDL[-1.853(-3.139,-0.567), P=0.005; I2=94.0%, P<0.001] in the statin group significantly decreased. But statins had no statistical significance in reducing TG [-1.303(-2.771,0.166), P=0.082; I2=94.0%, P<0.001] and increasing HDL [1.095(-0.852,3.043), P=0.27; I2=96.6%, P<0.001]. Meanwhile, the effect of statins on disease activity in patients with SLE was not statistically significant [-0.695(-1.889,0.500), P=0.254; I2=96.5%, P<0.001]. In addition, the statin group had no significant effect on reducing CRP[-0.609(-1.290,0.073), P=0.08; I2=90.6%, P<0.001] and CIMT[-0.149(-0.724,0.429), P=0.617; I2=42%, P=0.189].

Conclusion: Statins can reduce TC and LDL in SLE patients, but have no statistically significant effect on TG, HDL, SLEDAI, CRP and CIMT. Due to the high heterogeneity, the limitations of randomized controlled trials and the impact of other drugs included in the study, these results need to be carefully interpreted. Currently, a larger sample of high-quality studies are needed to verify this conclusion.