Background: Immune-mediated necrotizing myopathy (IMNM) associated with anti-HMG-CoA reductase antibodies is frequently associated to statin therapy due to significant dyslipidemia. Statin discontinuation poses challenges for lipid management and cardiovascular (CV) risk assessment. Alternative lipid-lowering strategies after statin discontinuation, and their effects on lipid profiles, are underexplored in this patient population. Sex differences in lipid profiles and the utility of the Atherogenic Index of Plasma (AIP) as a risk stratification tool remain underexplored in this population.

Objectives: To assess changes in lipid profiles (total cholesterol, LDL, HDL, triglycerides andAIP) following statin discontinuation. Secondary: To evaluate sex-based differences in lipid profiles and AIP, prevalence of comorbidities, and the impact of immunosuppressive treatments on lipid profiles and clinical outcomes.

Methods: An observational, retrospective study was conducted in a cohort of 45 patients diagnosed with IMNM at Hospital Clínic de Barcelona (2016–2024). Data from electronic medical records included demographic information, lipid profiles at disease onset and 4–6 months post-statin discontinuation, and treatment histories. Statistical analyses included Wilcoxon rank tests and Kruskal-Wallis tests. A key aspect of this study was also evaluating alternative lipid-lowering therapies prescribed after statin discontinuation and their impact on lipid profiles.

Results: Statin discontinuation resulted in significant increases in total cholesterol and LDL levels in patients switching to alternative therapies (p=0.036 and p=0.002) and in those who discontinued statins without new treatments (p=0.001 and p=0.004). Women exhibited higher baseline total cholesterol, LDL, and HDL levels compared to men, but men had significantly higher AIP at onset (p=0.012). Follow-up revealed persistent sex differences in total cholesterol (p=0.004) and LDL (p=0.027), while differences in AIP diminished. Immunosuppressive treatments did not significantly alter the lipid profiles, but their role in modifying cardiovascular risk requires further investigation.

Conclusion: Statin discontinuation exacerbates dyslipidemia in IMNM, underscoring the importance of alternative lipid-lowering therapies. Sex-based disparities in lipid profiles highlight the need for tailored CV risk management. AIP shows potential as a valuable tool for assessing residual CV risk in this population. Further studies are warranted to explore the impact of immunosuppressive therapies on lipid profiles and to identify the most effective lipid-lowering strategies in these patients. In addition, expanding the cohort size could provide more robust conclusions regarding sex differences and the effects of discontinuation.

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Acknowledgements: NIL.

Disclosure of Interests: None declared.

© The Authors 2025. This abstract is an open access article published in Annals of Rheumatic Diseases under the CC BY-NC-ND license ( http://creativecommons.org/licenses/by-nc-nd/4.0/ ). Neither EULAR nor the publisher make any representation as to the accuracy of the content. The authors are solely responsible for the content in their abstract including accuracy of the facts, statements, results, conclusion, citing resources etc.