Cardiovascular risk and lipid-lowering therapy in idiopathic inflammatory myopathies - a call for improved, disease-specific risk assessment

Sep 28, 2026

Letter to the editor presenting a retrospective clinical audit on cardiovascular risk estimation and lipid-lowering therapy use in idiopathic inflammatory myopathies (IIMs). The audit analyzed 74 patients, comparing anti-HMGCR and non-anti-HMGCR subgroups using QRISK3 and reviewing cholesterol management. Results show wide score variability, median QRISK3 higher than in the CARMA cohort, and under-treatment despite moderate to high calculated CV risk, especially in non-anti-HMGCR patients.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages2

Reading Time5 min

AccessFree to download

Background

Need for disease-specific cardiovascular risk assessment

Study design and patient cohorts

Retrospective clinical audit and subgrouping

Cardiovascular risk and treatment patterns

QRISK3 scores variability

Lipid-lowering therapy uptake

Clinical risk factors and comorbidities

Anti-HMGCR vs non-anti-HMGCR differences

Letter to the Editor (Other) Cardiovascular risk and lipid-lowering therapy inidiopathic inflammatory myopathies: a call for improved, disease-specific risk assessment Kimberly Loh 1,2, 􀀃 ,†, Emily Rose1,†, Sarah Tansley 1,2 1 Rheumatology Department, Royal United Hospital, Bath, UK 2 Department of Life Sciences, University of Bath, Bath, UK 􀀃 Correspondence to: Kimberly Loh, Rheumatology Research Unit, Wolfson Centre, D1, Royal United Hospitals Bath NHS Foundation Trust, Combe Park, Bath BA1 3NG, UK. E-mail: [drkimloh@gmail.com](drkimloh@gmail.com), [Kimberly.loh@nhs.net](Kimberly.loh@nhs.net) †K. L. and E. R. contributed equally to this study. DEAR EDITOR, We read with interest the recent article by Llorca et al. evaluating the performance of cardiovascular (CV) risk scales in chronic inflammatory rheumatic diseases (CIRDs) [1]. The CARMA project provides important longitudinal data demonstrating the variability of different risk prediction tools in the estimation of CV events. Their findings underscore the challenges of accurately assessing and managing CV risk in this population. While the CARMA cohort included rheumatoid arthritis and spondyloarthritis, idiopathic inflammatory myopathies (IIMs) remain underrepresented in such validation studies. We would like to contribute by sharing data from our recent retrospective study examining CV risk estimation and lipid-lowering therapy use in patients with IIMs. Evidence suggests that patients with IIMs are at increased risk of atherosclerotic CV mortality [2] . Optimising cholesterol and lipid management is one crucial component of CV health, yet statin use is underutilised, in part due to both patient and clinician concerns about statin-induced myopathy or muscle-related side effects [3] . While the available literature remains limited, existing evidence indicates that statins are generally well tolerated in non-anti-3-hydroxy-3-methylglutaryl-coenzyme A reductase (HMGCR) IIMs, and that alternative lipid-lowering agents (LLAs) may be safely employed in those with anti-HMGCR IIMs [4] . We performed a retrospective analysis of 74 patients attending the Myositis Clinic at the Royal National Hospital for Rheumatic Disease, Royal United Hospital, Bath, to evaluate cholesterol management and QRISK3 scores, with particular consideration of anti-HMGCR and non-anti-HMGCR subgroups. The work was done as a clinical audit to evaluate how well CV risk was being managed in IIM patients attending our clinic. Of the 74 IIM patients, 10 were anti-HMGCR positive, 16 were seronegative and 48 had other myositis-specific antibodies. Ethnicity data were available for 71 patients: WhiteBritish, 52/71 (73 .2%); White-other, 2/71 (2 . 8%); Asian 1/ 71,(1.4%); and Other-not stated, 16/71 (22.5%); 3 patients declined to answer. Among the 10 anti-HMGCR IIM patients (median age 70.5 years, 40% female), 9 (90%) had previously received atorvastatin, with 3 also trialling an alternative statin. All presented with muscle symptoms and elevated creatine kinase, with levels ranging from 5000 to 19 393 IU/L. Following diagnosis, statins were switched to an alternative LLA in 6/9 (67%) and completely ceased in 3/9 (33%) . In the 64 non-anti-HMGCR IIM patients (median age 63.5 years, 73% female), 7 (11%) had previously used statins that were ceased with no alternative LLA prescribed. Seventeen (27%) remained on LLA therapy, 4 of which were switched from a statin to a non-statin LLA: 10 on atorvastatin, 3 on ezetimibe, 1 on cholestagel, 1 on ezetimibe/perbromic acid, 1 on rosuvastatin and 1 on rosuvastatin plus ezetimibe. Forty patients (63%) had never received lipidlowering therapy. QRISK3 scores were calculated for 56 patients within the valid age range (25–84 years) with available data. There was considerable variability, with scores of 17–36% in the antiHMGCR group and 0.6–65.3% in the non-anti-HMGCR group. Median scores were similar between cohorts: 17.10%[interquartile range (IQR) 1

FAQs

What was the main purpose of the retrospective audit in IIM patients?

To evaluate cholesterol management and QRISK3-based cardiovascular risk estimation, and to assess how well lipid-lowering therapy was being used in idiopathic inflammatory myopathies, with focus on anti-HMGCR versus non-anti-HMGCR subgroups.

How were cardiovascular risk scores assessed in the study?

QRISK3 scores were calculated for patients within the valid age range who had available data, and results were compared between anti-HMGCR and non-anti-HMGCR cohorts.

What did the audit find about lipid-lowering therapy use despite calculated CV risk?

Even with moderate to high calculated CV risk (QRISK3 > 10%), a portion of anti-HMGCR and a much larger portion of non-anti-HMGCR IIM patients were not receiving any lipid-lowering therapy, indicating underutilisation.

Sep 28, 2026

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