Using statins may increase risk of diabetes, but reduce risk of CVD and death in rheumatoid arthritis

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A new study provides insight into the effects of statin therapy on the risk of diabetes and cardiovascular disease in patients with rheumatoid arthritis.

Presented at the annual meeting of the American College of Rheumatology, study results indicate that initiation of statins was associated with a 32% reduction in the risk of cardiovascular disease, a 54% reduction in the risk. all-cause mortality and a 33% increased risk of type 2 diabetes in patients with rheumatoid arthritis in a set of UK-based databases.

“We know that statins have been studied extensively in the general population, but our understanding of the effects of statins in patients with RA is limited and mainly based on a few studies. Since patients with RA already have a higher risk of CVD and type 2 diabetes compared to the general population, it is important to know the overall benefits and risks of statins, ”says Gulsen Ozen, MD, rheumatologist at the University of Nebraska Medical Center in Omaha. and co-author of the study, in a report.

Keen to develop a better understanding of the effects of statin initiation in patients with rheumatoid arthritis, Ozen and a team of colleagues from institutions across North America designed their study to examine related real-world data on initiation of statins using information from UK. Practice Research Datalink, Hospital Episode Statistics and Office of National Statistics databases. To be included in the prevalent cohort study of new users, patients had to be at least 18 years old with a diagnosis of rheumatoid arthritis and using at least 1 disease-modifying anti-rheumatic drug (DMARD) and no other diagnosis. from 1998-2018. Individuals were also required to have at least 1 year of baseline data available for analysis during the study period.

The statin initiators identified from the research were matched in a 1: 2 ratio to non-users based on temporal propensity scores (CST) which incorporated data including age, gender, BMI , smoking, alcohol, joint surgeries, history of cardiovascular disease, hypertension, rheumatic disease comorbidity index, osteoporosis and history of fracture, cancer, thyroid, chronic diseases of the liver, kidneys, lungs and other heart disease, healthcare utilization, DMARD, glucocorticoids, NSAIDs, and cardiovascular disease drugs.

The main outcome of interest for the study was cardiovascular disease outcomes, all-cause mortality, and type 2 diabetes. It should be noted that cardiovascular disease outcomes included myocardial infarction, stroke. , hospitalizations for heart failure and cardiovascular mortality. The presence of diabetes was based on diagnostic codes or on the prescription of diabetes treatment. The researchers emphasized that the risk of each outcome was assessed using Cox proportional hazards with adjustment for declines in TCPS and unbalanced patient characteristics after pairing.

The investigator’s initial search returned the records of 49,701 patients with a diagnosis of RA or a prescription for MRA. After applying the inclusion criteria, the investigators identified a total of 1,768 statin users and 3,528 non-users for inclusion in their analysis looking at cardiovascular disease and mortality and a total of 3,608 statin users and 7208 non-users for analysis looking at type 2 diabetes.

When assessing the incidence of cardiovascular disease, cardiovascular disease outcome was observed in 63 statin users and 340 non-users during the study period (3.0 per 100 person-years [PY] against 2.7 per 100 AP). When assessing the incidence of all-cause mortality, the results indicated that death occurred in 62 statin users and 525 non-users during the study period (2.7 per 100 AP against 4.1 per 100 AP). When assessing the incidence of diabetes, the results indicated that a new diagnosis of diabetes occurred among 128 statin users and 518 non-users (3.0 per 100 PA vs. 2.0 per 100 AP).

After analysis, the results suggested that initiation of a statin was associated with a 32% reduction in the risk of cardiovascular disease (RR: 0.68; 95% CI: 0.51-0.90), a 54% reduction in risk of all-cause mortality (RR: 0.46; 95% CI: 0.35-0.60) and 33% increase in risk of type 2 diabetes (RR: 1.33; 95% CI: 1.09-1.63). In addition, the results suggest that the NNT for preventing cardiovascular disease and 1-year mortality were 102 and 42, respectively, while the NNH for new diabetes was 127. Further analysis showed that patients with and without prior cardiovascular disease had similar reductions in the risk of cardiovascular disease (36% vs. 34%) and all-cause mortality (62% vs. 54%) with statin use.

“This may suggest that statins may have other beneficial effects in RA patients beyond lowering lipids. As rheumatologists, in addition to optimal control of disease activity, we must address the traditional risk factors for CVD in our patients in collaboration with their primary care providers. We believe our results emphasize the benefits of statins in patients with RA, ”added Ozen.

This study, “Reduction of cardiovascular disease and mortality versus risk of re-diabetes with statin use in patients with rheumatoid arthritis, ”Was presented at ACR Convergence 2021.

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