The Effect of Statin Use on Mortality in Systemic Autoimmune Rheumatic Diseases
April M Jorge1,2, Na Lu3,4, Sarah F Keller3,4
1From the Division of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA. AMJorge@mgh.harvard.edu.
Insights
Statin use in patients with Systemic Autoimmune Rheumatic Diseases (SARD) was associated with a significant reduction in all-cause mortality. This study highlights the survival benefits of statins for SARD patients, mitigating cardiovascular disease risks.
Area of Science:
- Rheumatology
- Cardiovascular Medicine
- Public Health
Background:
- Systemic autoimmune rheumatic diseases (SARD) increase the risk of premature cardiovascular disease (CVD) and mortality.
- Understanding survival benefits in SARD patients is crucial for clinical practice.
Purpose of the Study:
- To investigate the survival benefit of statin use in a general population of patients with SARD.
- To assess the impact of statin initiation on all-cause mortality in SARD patients.
Main Methods:
- A UK general population cohort study was conducted from 2000-2014.
- Propensity score matching compared statin initiators and non-initiators with SARD.
- Confounders like disease duration, BMI, lifestyle, comorbidities, and medications were adjusted for.
Main Results:
- Statin initiation was linked to reduced all-cause mortality (HR 0.84, 95% CI 0.72-0.98).
- Mortality rates were 25.4/1000 person-years for statin users vs. 30.3/1000 person-years for non-users.
- Unmatched analysis showed increased mortality in statin initiators due to confounding by indication.
Conclusions:
- Statin initiation reduces overall mortality in patients with SARD.
- Findings support statin use for improving survival in SARD patients after risk adjustment.
Objective:
Systemic autoimmune rheumatic diseases (SARD) are associated with an increased risk of premature cardiovascular disease (CVD) and all-cause mortality. We examined the potential survival benefit of statin use among patients with SARD in a general population setting.
Methods:
We conducted an incident user cohort study using a UK general population database. Our population included patients with a SARD as determined by Read code diagnoses of systemic lupus erythematosus, systemic sclerosis, Sjögren syndrome, dermatomyositis, polymyositis, mixed connective tissue disease, Behçet disease, or antineutrophil cytoplasmic antibodies-associated vasculitis between January 1, 2000, and December 31, 2014. We compared propensity score-matched cohorts of statin initiators and noninitiators within 1-year cohort accrual blocks to account for potential confounders, including disease duration, body mass index, lifestyle factors, comorbidities, and medication use.
Results:
Of 2305 statin initiators, 298 died during the followup period (mean 5.1 yrs), whereas among 2305 propensity score-matched noninitiators, 338 died during the followup period (mean 4.8 yrs). This corresponded to mortality rates of 25.4/1000 and 30.3/1000 person-years, respectively. Statin initiation was associated with reduced all-cause mortality (HR 0.84, 95% CI 0.72-0.98). When we compared the unmatched cohorts, the statin initiators (n = 2863) showed increased mortality (HR 1.85, 95% CI 1.58-2.16) compared with noninitiators (n = 2863 randomly selected within 1-year cohort accrual blocks) because of confounding by indication.
Conclusion:
In this general population-based study, statin initiation was shown to reduce overall mortality in patients with SARD after adjusting for relevant determinates of CVD risk.
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