Risks vs Benefits of Statin Use Among Patients With Rheumatoid Arthritis

Statin use is linked to reductions in cardiovascular disease (CVD) and all-cause mortality that outweigh the risks for incident type 2 diabetes (T2D) in patients with rheumatoid arthritis (RA), according to study results in Arthritis Care & Research.

Patients with RA have an increased risk for cardiovascular disease and T2D. Statins are known to improve CVD outcomes but they can also increase risk for T2D, though the relative benefits and risks in patients with RA is not known.

The aim of the study was to assess the risks related to mortality, CVD, and T2D with statin use in patients with RA.

The study cohort included patients with RA registered in the UK Clinical Practice Research Datalink (CPRD) between 1989 and 2018. Patients who were initiating treatment with statins were matched 2 patients who were not initiating statin treatment.

The primary study outcomes included an incident CVD event (fatal or nonfatal myocardial infarction, stroke, hospitalized heart failure, or CVD mortality), all-cause mortality, and incident T2D.

Hazard ratios of each outcome with statin use were calculated using the Cox proportional hazards model, adjusted for propensity score deciles and imbalanced covariables.

Among 1768 statin initiators and 3528 nonusers, CVD event rates were 3.0/100 person-years (PY) and 2.7/100 PY, respectively. All-cause mortality rates were 2.8/100 PY and 4.1/100 PY, respectively. Rates of incident T2D among 3608 statin initiators and 7208 nonusers were 3.0/100 PY and 2.0/100 PY, respectively.

Statin initiation was associated with 32% (HR, 0.68; 95% CI, 0.51-0.90) reduction in CVD, 54% (HR, 0.46; 95% CI, 0.35-0.60) reduction in all-cause mortality, and 33% (HR, 1.33; 95% CI, 1.09-1.63) increase in T2D. The number needed to treat to prevent a CVD event and mortality in 1 year was 102 and 42, respectively. The number needed to cause a new case of T2D was 127.

Limitations of the study included lack of sensitivity in the definition of RA, limited data regarding the use of biologic disease-modifying antirheumatic drugs (DMARDs) and RA disease activity, small numbers in the individual CVD event groups and intensive statin use, and the potential for residual confounding based on the observational study design.

The researchers concluded, “Given that patients [with RA] are less frequently assessed for CVD risk factors and even less frequently treated with statins than the general population, our findings emphasize the importance of statin initiation in eligible patients [with RA] with close monitoring for [T2D]. Statins have several pleiotropic effects beyond their lipid-lowering properties which may be a reason for higher all-cause mortality reduction than CVD mortality reduction. Further research would be helpful to identify other cause-specific mortality benefits of statins in RA.”

Disclosure: This research was supported by Bristol-Myers Squibb. Please see the original reference for a full list of authors’ disclosures.

Reference

Ozen G, Dell’Aniello S, Pedro S, Michaud K, Suissa S. Reduction of cardiovascular disease and mortality versus risk of new onset diabetes with statin use in patients with rheumatoid arthritis. Arthritis Care Res. Published online February 4, 2022. doi:10.1002/acr.24866