Effect of lipid-lowering drugs on endothelial function and vascular stiffness in patients with dermatomyositis and polymyositis: a prospective, double-blind, randomized controlled trial

Abstract

Dermatomyositis (DM) and polymyositis (PM) are idiopathic inflammatory myopathies characterized by the presence of progressive proximal muscle weakness of limbs. Metabolic syndrome (MS) is a series of biochemical and physiological disorders characterized by fasting plasma glucose change, central obesity, dyslipidemia and hypertension. The clinical relevance of MS is related to its role in the development of cardiovascular diseases and diabetes mellitus. The presence of MS is also directly related to endothelial dysfunction of the vascular and arterial stiffness, which lead to increased cardiovascular morbidity and mortality.There are few studies that describe the prevalence of MS in systemic autoimmune rheumatic diseases varying from 14 to 62.8% and, therefore, higher than in the general population. This high prevalence suggests that the presence of these systemic autoimmune diseases or instituted treatment influence the risk of developing MS. Our research group has pioneered demonstrated a high prevalence of MS in patients with DM/PM, characterized by elevated serum levels of total cholesterol, LDL-cholesterol and triglycerides, and low serum HDL-cholesterol.The high MS prevalence, particularly dyslipidemia, in DM/PM, along with the chronic use of corticosteroids, presence of functional disability, sedentary lifestyle or even bed rest for some patients, increase cardiovascular risk and mortality in this population. The identification of risk factors for cardiovascular disease in patients with DM/PM is important in clinical practice so that we can carry out early intervention mainly on modifiable risk factors and, therefore, minimizing cardiovascular risks.This study is a clinical double-blind randomized trial. It is part of a series of clinical trials that aim increase the knowledge of lipid-lowering drug effect on endothelial function and vascular stiffness in patients with DM and PM. Until now, the real impact on the lipid-lowering therapy in patients with diagnosis of DM/PM. Although not scientifically proven, it is believed that these drugs may eventually relapse or worse disease activity. For this reason their use in medical practice in this population has been avoided. Moreover, the impact of the use of lipid-lowering drugs on endothelial function and arterial stiffness in patients with DM/PM is also unknown, which motivated us to conduct this study. (AU)