Statin Initiation Reduces Overall Mortality in Systemic Autoimmune Rheumatic Diseases

In patients with systemic autoimmune rheumatic diseases, the initiation of statin therapy is associated with reduced overall mortality after adjusting for relevant determinants of risk for cardiovascular disease, according to the results of an incident user cohort study published in The Journal of Rheumatology.

The investigators used data from a general UK population database to examine the potential survival benefit of statin use in patients with systemic autoimmune rheumatic diseases in a general population setting. The patient population in the current study included individuals with a rheumatic disease based on a Read code diagnosis of systemic lupus erythematosus, systemic sclerosis, dermatomyositis, polymyositis, Sjogren syndrome, mixed connective tissue disease, Behcet disease, or antineutrophil cytoplasmic antibodies-associated vasculitis between January 1, 2000, and December 31, 2014.

To account for potential confounders, including BMI, disease duration, comorbidities, lifestyle factors, and medication use, the researchers compared propensity score-matched cohorts of statin initiators and non-initiators in 1-year cohort accrual blocks.

Of 2305 statin initiators, 298 individuals died during the follow-up period (mean, 5.1 years). In contrast, in 2305 propensity score-matched non-initiators, 338 individuals died during the follow-up period (mean, 4.8 years). These values correspond to mortality rates of 25.4 per 1000 person-years in statin initiators vs 30.3 per 1000 person-years in statin non-initiators. Statin use was associated with reduced all-cause mortality (hazard ratio [HR], 0.84; 95% CI, 0.72-0.98).

When unmatched cohorts were compared, statin initiators (n=2863) demonstrated increased mortality rates (HR, 1.83; 95% CI, 1.58-2.16) compared with non-initiators (n=2863) because of confounding by indication.

The investigators concluded that the appropriate use of statins may be beneficial in decreasing premature mortality in patients with systemic autoimmune rheumatic diseases. The use of a large general population database in this study rendered the results generalizable and permitted the researchers to identify large numbers of patients with these rare conditions who have sufficient follow-up data available to evaluate mortality outcomes. The researchers noted that the study was not powered to specify the relative effect of statins on morality rates in each individual systemic autoimmune rheumatic diseases disorder.

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Reference

Jorge AM, Lu N, Keller SF, Rai SK, Zhang Y, Choi HK. The effect of statin use on mortality in systemic autoimmune rheumatic diseases [published online September 1, 2018]. J Rheumatol. doi:10.3899/jrheum.171389