Statin Use and Mortality in Patients with Rheumatoid Arthritis
BACKGROUND: Patients with rheumatoid arthritis (RA) have higher rates of mortality compared to the general population. This is most likely due to the inflammatory nature of this disease and the burden of cardiovascular complications that are associated with it. Previous literature indicates that treatment with statin therapy may play a role in further reducing the mortality rate of patients with RA.
OBJECTIVE: To determine statin use in patients with RA reduced all-cause mortality rates.
METHODS: Patients with a diagnosis of RA in the University of Utah Data Warehouse from 2007 – 2015 were included and reviewed for use of statin medication. Patients who started statin medication prior to RA diagnosis were excluded. The primary endpoint was all-cause mortality defined by the date of death in the data warehouse. Propensity score matching was utilized to adequately balance groups and account for potential confounders. Patients were matched 1:1 on age, gender, BMI, comorbidities, and medication use. Tests for statistical significance and Cox Proportional Hazards Regression were utilized for analysis of the primary outcome.
RESULTS: Baseline characteristics for each group were well balanced after matching. The hazards ratio for all-cause mortality in patients with rheumatoid arthritis for statin users was 0.70 (95% CI 0.55 – 0.89; p <0.001) compared to non-statin users. In patients with rheumatoid arthritis, statin initiation was associated with a 30% lower risk of all-cause mortality.
CONCLUSION: Patients with RA who use statin medications have lower rates of all-cause mortality. The utility of statins in this population supports integrating them into current guidelines.Published in College of Pharmacy, Virtual Poster Session Spring 2020
Wow, these are really interesting findings. It’s amazing to learn about different drugs and their benefits in different disease states. This information is so relevant clinically and it will be interesting to see how these findings change practice.
Thank you for your comment! I agree, it was really fascinating to see just how big of an impact this class of medications could have on this specific subset of patients. Hopefully statins will be integrated into RA guidelines soon!
Savannah – Super excited to see the results of your work.
1) Do you think if there are any major differences of the groups receiving no statin and statin that may explain the findings? I can see that you try to control with PS matching already.
2) Just wonder if there is any guidelines in RA specifiying the need of using Statin in this population. I can see that your work may impact clinical practice guideline in this field.
3) Can you do the analysis and see if different statin or dose or its effect on Lipid profile has any effect on different mortality rate reduction? At least, if you can’t do it, it might be suggested in your discussion as future research direction.
Thank you for your comment Dr. Chaiyakunparuk! We tried to control for as many variables as possible between the two groups because we suspected that there would be major baseline differences between statin users vs nonusers. We tried to control for many cardio-related disease states and medication use but I’m sure that there are other confounders that we could have controlled for. Some lifestyle factors that we were not able to collect or control for due to limitations with our data set including smoking and alcohol use – these could have potentially impacted our findings. The most current RA guidelines do not recommend statin therapy. We are hopeful that our findings help support the integration of statin therapy into current guidelines! And we were not able to do an analysis of statin dosing for mortality benefit but I definitely think that this would be an important area to look at in the future. I would imagine that minimally patients would need a moderate-intensity statin (but could possibly require high intensity based on their lipid profile).
Excellent work, Savannah. Any thoughts on why statins might be associated with the mortality benefit in this population? You mention anti-inflammatory effect, but are there other possible explanations?
Hi Dr. Witt! There are a few explanations that we think may explain this association. First, as you mentioned, includes the anti-inflammatory effects of statins. We also believe that, based on previous research, statins may also have a positive impact on structural, morphological and biochemical parameters of vascular function in RA patients, which may also help to explain the mortality benefit. Finally, we also believe that the lipid-lowering effects of statins also contribute to the overall mortality benefit seen in these patients. Thank you for your comment and I hope that you have a great summer!
This is so cool. I will definitely keep this topic in mind and hope to see the research you mention that can magnify statins’ utility and hopefully lead to their integration in the RA guidelines! I’m gonna scan the future RA guidelines for your names.
Hi Michael! Thank you so much for your kind words. Statins for everyone!! 🙂
That sounds like a potentially very powerful outcome! Very exciting. Are there any trials being planned or will they just go directly to use in this patient population?
Hello Dr. Lim! As of now, there are no trials being planned. There have been several studies that have shown a similar benefit – and because of that, we are hopeful that statins can be directly integrated into guidelines so that more patients can see the benefit of this class of medication.
very nice study. the propensity scoring methodology does a good job of adjusting for treatment selection bias. Another factor to consider is whether there was a significant differences in baseline LDL level between the two groups. I didn’t see this reported in the table. Can you comment on this as a risk factor in addition to the RA?
Hello Dr. Malone! I think that that is a very valid point and something that is definitely a risk factor for increased mortality. Due to limitations with our data set, we were not able to control for baseline LDL levels and other important confounders, including lifestyle factors like smoking and alcohol use. I think that these are definitely important variables to take into consideration and could be controlled for in future studies. I know that a few similar studies have been done that did control for LDL and still found the same benefit. Thank you for your comment!
Wow these results are exciting! great work Savannah!
Thank you Sean! Great work to you too! Congratulations on graduation and best of luck with residency!
Great job, Savannah! Super cool study.
Thank you Taylor! I’m so happy that we both had the chance to present our findings at the ACCP NYC meeting this past year. Best of luck with residency and your future endeavors!
Wow, Savannah. Very interesting study, I’m glad I’m on a statin after all!
Hi Dr. Barrows! Yes!! Statins for everyone! Thank you so much for your kind words. I’m glad that I was able to complete this interesting project and hope that these findings will make a difference in future guidelines!
Savannah, Nice work! It’s fascinating to consider the possibility that regardless of the cardiovascular risk factor, putting RA patients on the statin may decrease all-cause mortality. Your findings may really impact people’s lives. Way to go!
Hi Dr. Keefe! Thank you so much for your kind words. I’m also hopeful that these findings may have an impact on patient care in the future. I was lucky to have an awesome project mentor and great course leaders like yourself to help me complete this project. Thank you and I hope you have a great summer!
Great poster Savannah! I think that it is really interesting that comorbidities did not affect your results. Great job!
Hi Taylor! I also found that very interesting! Thank you for your comment. Best of luck with residency and CONGRATS on being finished with pharmacy school!!
Great poster and the results of your conclusion sure seem exciting for rheumatoid arthritis patients.
Sure excited you’ll be finishing soon! Congratulations
Thank you Judy! I’m glad that I was able to complete this project and hopefully have a positive impact on future RA guidelines. It has been a wonderful four years – thank you for all of your support along the way! I hope that you stay safe and healthy during this crazy time.
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