title: Influence of atorvastatin on coronary calcifications and myocardial perfusion defects in systemic lupus erythematosus patients: a prospective, randomized, double-masked, placebo-controlled study.
abstract: BACKGROUND
  Mortality in systemic lupus erythematosus (SLE) patients is influenced by an increased occurrence of severe cardiovascular complications. Statins have been proven to protect a wide spectrum of SLE patients from these complications. This study was conducted to determine the possible efficacy of atorvastatin in SLE patients as assessed by multi-detector computed tomography (MDCT)-based coronary calcium scoring and single photon emission computed tomography (SPECT) of the myocardium.
  
  
  METHODS
  Sixty SLE patients in stable clinical conditions were randomized to receive either atorvastatin (40 mg daily; n = 28) or placebo (n = 32). Clinical and biochemical evaluation together with MDCT-based coronary calcium scoring and SPECT studies (Tc-99 m sestamibi) were performed at the time of randomization and after 1 year of treatment.
  
  
  RESULTS
  At randomization, SPECT revealed perfusion defects at rest in 22 (36.7%) patients and exercise-induced defects in 8 (13.3%), whereas MDCT revealed coronary calcifications in 15 subjects (25%). Coronary calcium deposits increased after 1 year in the placebo group (plaque volume change from 35.2 ± 44.9 to 62.9 ± 72.4, P < 0.05; calcium score from 32.1 ± 39.1 to 59.5 ± 64.4; P < 0.05), but not in the atorvastatin group (plaque volume 54.5 ± 62.4 vs. 51.0 ± 47.6, P not significant; calcium score 44.8 ± 50.6 vs. 54.9 ± 62.5, P not significant). The atorvastatin group showed a decrease in total serum cholesterol (from 5.1 ± 1.2 to 4.4 ± 0.7 mmol/L, P < 0.05), LDL cholesterol (2.9 ± 1.0 to 2.3 ± 0.6 mmol/L, P < 0.05), triglycerides (1.6 ± 0.6 to 1.2 ± 0.5 mmol/L, P < 0.05), and C-reactive protein (CRP) (4.4 ± 4.1 to 2.7 ± 1.7 mg/L, P < 0.05). There was no change in the mean Systemic Lupus Erythematosus Disease Activity Index (SLEDAI) score in patients from both groups. Perfusion defects observed at randomization showed no change after one year treatment with atorvastatin.
  
  
  CONCLUSIONS
  In SLE patients 40 mg of atorvastatin daily for 1 year led to a decrease in serum lipids and CRP levels. Additionally the progression of atherosclerosis, as assessed by MDCT-based coronary calcium scoring, is restrained by atorvastatin treatment. The value of statin treatment in patients with SLE free from cardiovascular disease clinical symptoms should be addressed in large, prospective clinical trials.
authors.affiliation: Department of Cardiac and Vascular Diseases, John Paul II Hospital, Jagiellonian University Medical College, Pradnicka Str 80, 31-202 Krakow, Poland. wplazak@szpitaljp2.krakow.pl
authors.forename: Wojciech
authors.initials: W
authors.lastname: Plazak
authors.forename: Krzysztof
authors.initials: K
authors.lastname: Gryga
authors.forename: Hanna
authors.initials: H
authors.lastname: Dziedzic
authors.forename: Lidia
authors.initials: L
authors.lastname: Tomkiewicz-Pajak
authors.forename: Malgorzata
authors.initials: M
authors.lastname: Konieczynska
authors.forename: Piotr
authors.initials: P
authors.lastname: Podolec
authors.forename: Jacek
authors.initials: J
authors.lastname: Musial
mesh_terms: D000328:Adult; D000368:Aged; D000069059:Atorvastatin; D002114:Calcinosis / Q000000981:diagnostic imaging / Q000209:etiology / Q000517:prevention & control*; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging / Q000209:etiology / Q000517:prevention & control*; D003331:Coronary Vessels / Q000000981:diagnostic imaging; D004311:Double-Blind Method; D005260:Female; D006321:Heart / Q000000981:diagnostic imaging; D006538:Heptanoic Acids / Q000627:therapeutic use*; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use*; D008180:Lupus Erythematosus, Systemic / Q000150:complications / Q000000981:diagnostic imaging* / Q000188:drug therapy; D008297:Male; D008875:Middle Aged; D064847:Multimodal Imaging; D055414:Myocardial Perfusion Imaging; D009206:Myocardium; D049268:Positron-Emission Tomography; D011446:Prospective Studies; D011758:Pyrroles / Q000627:therapeutic use*; D014057:Tomography, X-Ray Computed; D055815:Young Adult
chemical_list: D006538:Heptanoic Acids; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D011758:Pyrroles; D000069059:Atorvastatin