Study links statin use to lower mortality in RA patients

Among adults with rheumatoid arthritis, starting a statin prescription led to a 21% drop in risk of dying from any cause, compared with not using statins, according to a study published online Aug. 5 in Annals of the Rheumatic Diseases.

The size of the protective effect resembled results from trials of patients without RA and somewhat exceeded those from population-level analyses of statins as preventive therapy, reported Dr. Sara Schoenfeld of Harvard Medical School, Boston.

“Although the differences were small, this finding may not be surprising, as patients with RA are at a higher risk for cardiovascular disease than the general population, and might benefit from the dual anti-inflammatory and lipid-lowering effects of statins in a way that the general population might not,” wrote Dr. Schoenfeld and her colleagues.

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Few studies have examined statin use in patients with RA, and a recent randomized trial, TRACE-RA (Ann Rheum Dis. 2015;74:688), was halted early because of a low event rate, the investigators noted.

To further explore the issue, they compared matched cohorts of RA patients who were at least 20 years old, were listed in a general practice medical records database from the United Kingdom, had used at least one disease-modifying antirheumatic drug between 2000 and 2012, and had either started statins or not during the year they were added to the study.

The investigators excluded current or former statin users to help prevent selection bias, and they excluded patients with missing data on relevant risk factors, such as body mass index or smoking status (Ann Rheum Dis. 2015 Aug. 5 doi: 10.1136/annrheumdis-2015-207714).

Over a median of 4.5 years of follow-up, 432 of 2,943 patients with RA who started statins died, for an incidence rate of 32.6 deaths per 1,000 person-years, which was substantially less than the rate of 40.6 per 1,000 person-years among those who did not use statins, the investigators reported. Thus, starting statins was linked to a 21% lower likelihood of all-cause mortality (hazard ratio, 0.79; 95% confidence interval, 0.68 to 0.91), they said. The hazard ratio was similar when they defined RA based on diagnostic code only, without requiring use of DMARDs for the case definition (HR, 0.81; 95% CI, 0.74 to 0.90).

“Our findings expand previous evidence for the beneficial effects of statins in RA, which have been indirectly drawn from studies evaluating intermediate markers of cardiovascular disease and premature mortality in RA, antirheumatic and lipid findings from studies evaluating RA disease outcomes, and studies evaluating statin effects in other patient populations, such as the JUPITER trial,” the researchers said.

The comparison groups were well balanced in terms of baseline demographic traits, comorbidities, total cholesterol levels, and use of cardiovascular medications, nonsteroidal anti-inflammatory drugs, glucocorticoids, and biological agents, but the medical records database usually lacked information on cause of death, the researchers noted. “We hypothesize that the lower mortality rate associated with statin use stems from the reduction of cardiovascular-specific mortality in patients with RA, and this speculation calls for future studies that examine cause-specific mortality outcomes,” they concluded.

The National Institutes of Health partly funded the work. The investigators declared having no competing interests.