Abstract Background Patients diagnosed with systemic lupus erythematosus (SLE) face an elevated risk for early-onset atherosclerosis. Despite this risk, the effectiveness of statins in mitigating the progression of atherosclerosis within this demographic remains unclear. Purpose This systematic review and meta-analysis aimed to assess the impact of statins therapy on markers of atherosclerosis and lipid profiles among patients with SLE. Methods A systematic search of PubMed, EMBASE, and Cochrane databases was conducted for randomised controlled trials (RCTs) comparing the use of statins and placebo in patients with SLE. Eligible studies reported outcomes such as carotid intima-media thickness (CIMT), coronary artery calcium score (CAC), high-sensitivity C-reactive protein (hs-CRP), the Systemic Lupus Erythematosus Disease Activity Index (SELAID), LDL and total cholesterol. We pooled mean difference (MD) and standardized mean differences (SMD) along with 95% confidence intervals (CI) using a random-effect model. All statistical analyses were performed using R version 4.4.2. Results Our meta-analysis included six RCTs comprising 668 patients, of whom 333 (49.8%) were randomised to receive statin therapy. The average age of participants was 39 years, with a range of 15 to 51 years across the studies, and the mean follow-up duration was 18.5 months. Statin therapy significantly reduced hs-CRP (MD -0.61; 95% CI -1.12; -0.11; p=0.017; figure 1A), LDL cholesterol (SMD -1.36; 95% CI -2.28; -0.45; p=0.003; figure 1B) and total cholesterol (SMD -1.01; 95% CI -1.67; -0.35; p=0.003) compared to placebo. No significant differences were observed in CIMT (MD -0.0047; 95% CI -0.017; 0.0075; p=0.45; figure 2A), CAC (SMD -0.10; 95% CI -0.34; 0.15; p=0.45; figure 2B), or SELAID (SMD -0.72; 95% CI -2.36; 0.91; p=0.38) between groups. Conclusion Statin therapy in patients with SLE significantly reduced hs-CRP, LDL and total cholesterol. However, no significant changes were observed on CIMT, CAC, or SELAID. The relatively short follow-up duration and the younger age of participants highlight the need for larger, long-term RCTs to further assess the cardiovascular benefits of statins in this population.
Portilho et al. (Sat,) studied this question.