C-reactive protein did not exert a linear effect on plaque progression or on the appearance of incident plaque until it reached 12 mg/L or more. This threshold of change was significantly lower in patients with higher Framingham scores or diabetes at baseline (5 mg/L)
The role of statins in modifying progression is complicated, the authors stated. "Notably, statin use was associated with almost no progression of [common carotid plaque] in RA patients with longer disease duration, an observation supporting the use of statins in RA," they said. "Interestingly, however, statin use was not associated with lower [common carotid progression] among participants with earlier disease. This may suggest differing mechanisms for [common carotid plaque] progression in early vs. late disease."
The additional finding that statins attenuated the risk exerted by glucocorticoid exposure "deserves additional study and, short of a confirmatory trial, suggests that statins could be considered in RA patients receiving glucocorticoids."
The ESCAPE RA trial was primarily sponsored by the National Institutes of Health. The subanalysis was sponsored by the American College of Rheumatology Research and Education Foundation. None of the authors reported any financial conflicts.