More pros than cons for the use of statins in RA

Rheumatoid arthritis (RA) patients benefit from significant reductions in cardiovascular and all-cause mortality when treated with statins. The advantages of statin treatment outweigh the modest risk of diabetes resulting from the therapy.

“Only few studies so far have shown that statins improve endothelial function, atherosclerotic plaques, and even disease activity in patients with RA. Few studies also showed that statins can reduce cardiovascular disease and all-cause mortality in RA with a wide range of magnitude,” Dr Gulsen Ozen (University of Nebraska Medical Center, NE, USA) pointed out [1]. Unlike for the general population, data on the type 2 diabetes mellitus (T2DM) risk associated with statin use is still limited in RA patients. “As we know, T2DM is an important concern in RA, because it not only increases and worsens cardiovascular outcomes but also some infection and cancer incidences and outcomes which are other causes of mortality in RA,” underlined Dr Ozen.

To assess the risk/benefit profile of statin medication regarding mortality, cardiovascular disease, and T2DM of patients with RA, Dr Ozen and her colleagues performed an observational study, utilising 3 large databases: UK Clinical Practice Research Datalink, Hospital Episode Statistics, and Office of National Statistics. Included were 1,768 statin initiators and 3,528 matched non-users for the assessment of cardiovascular disease and all-cause mortality, along with 3,608 statin users and 7,208 propensity-matched non-users for the evaluation of T2DM in RA. The mean age within the cohorts was 65 years, and the mean duration of RA was 4–5 years.

In the entire cohort, statin use was significantly linked to a decrease of 32% in cardiovascular events and a 54% decrease in all-cause mortality on the one hand, and a 33% elevated risk of T2DM (see Figure). “We assessed patients with or without cardiovascular disease, and we found that both groups had similar cardiovascular event reduction, all-cause mortality reduction, and T2DM risk increase with statins. However, only the diabetes risk significantly increased in patients without prior vascular disease,” Dr Ozen elaborated. She also highlighted that the numbers needed to prevent 1 cardiovascular event or 1 death from any cause by 1 year of statin treatment were 102 or 42, respectively, whereas 127 persons would have to be exposed to statins over the same period, to cause 1 new onset of T2DM.

Figure: Association between the initiation of statin use and various outcomes (as treated analysis) [1]



*Due to imbalance in time-conditional propensity score matching, hazard ratios are adjusted for age, gender, deciles of propensity score, aspirin, beta-blockers, ACB/ARBs, cerebrovascular disease, thiazide diuretics, diabetes and its medications with the latter 3 only for CVD and mortality

“Given that statins are still underutilised in patients with RA, our findings emphasise the statin initiation in eligible patients with monitoring for T2DM while on treatment. As statins may have potential pleotropic and anti-inflammatory effects, they may be offering further benefits on other causes of mortality in RA,” Dr Ozen concluded.

1. Ozen G. Reduction of cardiovascular disease and mortality versus risk of new onset diabetes with statin use in patients with rheumatoid arthritis. Abstract 1427, ACR Convergence 2021, 03–10 November.

 

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Posted on 14 January 2022