A new study puts a twist in the theory that statins could conveniently serve dual purposes in patients with inflammatory diseases that affect both the joints and heart.
Findings from the investigation, involving 5,678 women aged 65 and older, suggest that the use of statins appeared to modestly increase a woman's risk of developing new relatively severe radiographic hip osteoarthritis.
However, statin use did not appear to affect the progression of disease in patients who already had osteoarthritis, reported Mary S. Beattie, M.D., and her associates at the University of California, San Francisco (J. Rheumatol. 2005;32:106-10).
The rationale for the study was based on the fact that while statins are increasingly recognized for their broad anti-inflammatory effects, they have also been shown to increase the production of nitric oxide, which could have a deleterious effect on the cartilage matrix, the investigators said.
The researchers monitored the women, all of whom were white and aged 65 and older, for radiographic evidence of new-onset disease as well as for the progression of established radiographic hip osteoarthritis (RHOA) over an 8-year period. All the women had already been participants in a multicenter study of osteoporotic fractures.
Overall, 7% (397) of the women were statin users, and these women demonstrated nearly twice the risk of developing severe disease, defined radiographically as a summary grade of 3 or greater on the modified Croft scale.
At baseline, 4,933 women had no RHOA in either hip; 566 women had developed new, radiographic evidence of disease in 630 hips by the fifth follow-up visit. Of the 745 women who had RHOA in 936 hips at baseline, the disease worsened in 484 hips among 420 women.
Evidence of new-onset radiographic disease was deemed present if any of five criteria were met: a summary grade of 2 or greater; a minimum joint space (MJS) of 1.5 mm or less; joint space narrowing superolaterally of 2 or greater and superomedially of 3 or greater; or definite osteophytes in any location.
Radiographic progression was deemed present if the MJS decreased by 0.5 mm or more; summary grade increased by 1 or greater; or the osteophyte score increased by 2 or more.
Only 26 (6.5%) of the statin users showed signs of progressive disease. There was a moderate, but not statistically significant, trend toward a decreased risk of OA progression among statin users.
Women who showed signs of progressive RHOA were less likely to be taking vitamin D, compared with women whose disease did not progress (42.6% vs. 51.5%); however, the odds ratio was not statistically significant. There were no significant differences between those with and without RHOA in terms of age, BMI, and walking for exercise.
The study findings are limited by the fact that the investigation included only white women and a small number of statin users.
Evidence suggests that the use of statins can slightly improve symptoms among rheumatoid arthritis patients, Christopher J. Penney, M.D., of the University of Calgary (Alta.), noted in an accompanying editorial.
“The quite modest effect of statins in the management of human rheumatic disease may be related to the dose or to the differences between mouse, man, and test tube,” he said, adding that more prospective trials of statins are needed to determine whether the effects are clinically significant (J. Rheumatol. 2005;32:17-9).
“Obesity is the common denominator for the presence of high cholesterol and hip osteoarthritis in women, and this may explain the results of this trial,” Roy D. Altman, M.D., an osteoarthritis specialist in Agua Dulce, Calif., said in an interview.
The researchers alluded to the relationship between obesity and hip osteoarthritis in women by adjusting for height and weight, but they did not specifically adjust for BMI, noted Dr. Altman, a member of the RHEUMATOLOGY NEWS editorial advisory board.