Assessment of lipid-lowering therapies in high-risk patients with inflammatory joint diseases-Insights from a preventive cardio-rheuma clinic.

Background: A disparity exists between adherence to guideline recommendations for cardiovascular (CV) prevention and achieving low-density lipoprotein cholesterol (LDL-C) goals in clinical practice. The aim was to assess the effectiveness of lipid-lowering therapies in high- and very high-risk patients with coexisting inflammatory joint diseases (IJD).

Methods: This quality assurance project included all consecutive patients with IJD referred to a CV risk evaluation between 2019 and 2024 to a single clinic in Norway. According to guidelines, patients categorized as high- or very high-risk of atherosclerotic CV disease received lipid-lowering therapies. The patients were followed every 1 to 3 months for monitoring and evaluation of LDL-C levels.

Results: In total, 264 of 414 referred patients with IJD were classified as having high (n = 25) or very high (n = 239) risk and 229 patients completed treatment. Total cholesterol and LDL-C from baseline to final consultation were significantly reduced (mean ± SD) by 1.88 ± 1.1 and 1.81 ± 1.1 mmol/L, respectively. The median LDL-C at the end of follow-up was 1.6 (IQR: 1.1-1.9) mmol/L and 1.4 (IQR: 1.2-1.5) mmol/L for high- and very high-risk patients, with median reductions of 59% and 56%, respectively. At the end of follow-up, 70% of the high-risk patients were on combination lipid-lowering therapy.

Conclusions: Significant reductions in LDL-C levels are achievable in a large proportion of high-risk patients with IJD. These findings suggest that combination therapy, frequent monitoring and individualized treatment strategies, including lifestyle management, may play a crucial role in CV prevention in high-risk populations.