All-Cause Mortality in RA Decreased With Statin Use

TOPIC SERIES: CVD PREVENTION IN RHEUMATIC DISEASE

Initiation of statin therapy is associated with a lower risk of mortality among patients with rheumatoid arthritis (RA), according to research published in the Annals of Rheumatic Diseases.

Hyon K Choi, MD, Division of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital, Harvard Medical School, Boston, and colleagues, conducted an incident user cohort study to examine the link between statin use and overall mortality in RA patients, in the context of the general population.

Study population included patients ≥20 years of age with a diagnosis of RA who had been prescribed at least 1 disease-modifying antirheumatic drug (DMARD) between January 2000 and December 2012.

During follow-up, 432 deaths were recorded among 2943 statin initiatiors; incidence rate was calculated at 32.6 per 1000 person-years; 513 deaths were recorded among 2943 matched comparators for an incidence rate of 40.6 per 1000 person years.

“In this large cohort study of patients with RA … we found that statin initation was associated with a 21% lower risk of all-cause mortality among patients with RA,” noted Dr Choi (HR=0.79, 95% CI 0.68 to 0.91).

“Importantly,” continued Dr Choi, “the magnitude of inverse association between statin use and mortality was similar to that found in many previous studies of non-RA patients.”

Summary and Clinical Applicability

This study was the first to evaluate the association of statin initiation with all-cause mortality in patients with RA, irrespective of patient history of cardiovascular disease.

The researchers noted that these associations were independent of age, sex, BMI, socioeconomic status, relevant comorbidities, CV medication use, total cholesterol levels, and healthcare utilization.

Limitations and Disclosures

Limitations did exist in this study. While the researchers did note a lower mortality risk associated with statin initiation, they were unable to examine cause-specific mortality. Additionally, because the study was conducted as a complete case analysis that excluded patients with missing values, the possibility exists that the pool of statin non-users may have been affected.

Finally, the matched comparator cohort was well balanced for use of glucocorticoids, NSAIDs, and biological agents; all patients were required to be using a DMARD.

Reference

Schoenfeld SR, Lu L, Rai SK, et al. Statin use and mortality in rheumatoid arthritis: a general population-based cohort study. Ann Rheum Dis. 2016;75:1315-1320; doi: 10.1136/annrheumdis-2015-207714