Reduction of Cardiovascular Disease and Mortality Versus Risk of New-Onset Diabetes Mellitus With Statin Use in
Gulsen Ozen1, Sophie Dell'Aniello2, Sofia Pedro3
1University of Nebraska Medical Center, Omaha.
Insights
For rheumatoid arthritis (RA) patients, statin use significantly reduces cardiovascular disease (CVD) and all-cause mortality risks. The benefits of statins in RA patients outweigh the small increased risk of type 2 diabetes mellitus (DM).
Area of Science:
- Rheumatology
- Cardiology
- Endocrinology
Background:
- Rheumatoid arthritis (RA) is associated with an increased risk of cardiovascular disease (CVD).
- The role of statins in mitigating CVD risk and other outcomes in RA patients requires further investigation.
Purpose of the Study:
- To evaluate the impact of statin therapy on cardiovascular disease (CVD) risk.
- To assess the effect of statins on all-cause mortality.
- To determine the association between statin use and the incidence of type 2 diabetes mellitus (DM) in patients with rheumatoid arthritis (RA).
Main Methods:
- A prevalent new-user cohort design was employed using data from the UK Clinical Practice Research Datalink (1989-2018).
- Patients initiating statins were matched with concurrent non-users using time-conditional propensity scores (TCPS).
- Cox proportional hazards models were used to estimate hazard ratios (HR) for CVD, all-cause mortality, and incident type 2 DM.
Main Results:
- Statin initiation was associated with a 32% reduction in CVD risk (HR 0.68) and a 54% reduction in all-cause mortality (HR 0.46).
- A 33% increase in the risk of type 2 DM was observed with statin use (HR 1.33).
- The number needed to treat to prevent one CVD event or death in one year was 102 and 42, respectively; the number needed to harm for type 2 DM was 127.
Conclusions:
- Statin therapy significantly reduces cardiovascular disease (CVD) and all-cause mortality in patients with rheumatoid arthritis (RA).
- The observed benefits of statins in reducing CVD and mortality risk outweigh the modest increase in type 2 diabetes mellitus (DM) risk.
Objective:
To assess the effect of statin use on the risk of cardiovascular disease (CVD), all-cause mortality, and type 2 diabetes mellitus (DM) in patients with rheumatoid arthritis (RA).
Methods:
We identified a cohort of patients with RA between 1989 and 2018, within the UK Clinical Practice Research Datalink. We employed a prevalent new-user cohort design by which patients initiating statins were each matched to 2 concurrent nonusers by the time-conditional propensity score (TCPS). Patients were followed until the occurrence of the composite end point of myocardial infarction, stroke, hospitalized heart failure or CVD mortality, all-cause mortality, and incident type 2 DM. The Cox proportional hazards model was used to estimate the hazard ratio (HR) of each outcome associated with as-treated statin use, with adjustment for TCPS deciles and imbalanced covariables.
Results:
Among 1,768 statin initiators and 3,528 nonusers, 63 versus 340 CVD (3.0 per 100 person-years versus 2.7 per 100 person-years) and 62 versus 525 deaths (2.8 per 100 person-years versus 4.1 per 100 person-years) occurred. Incident type 2 DM was noted in 128 of 3,608 statin initiators (3.0 per 100 person-years) and 518 of 7,208 nonusers (2.0 per 100 person-years). Statin initiation was associated with 32% (HR 0.68 [95% confidence interval (95% CI) 0.51-0.90]) reduction in CVD, 54% (HR 0.46 [95% CI 0.35-0.60]) reduction in all-cause mortality, and 33% increase in type 2 DM (HR 1.33 [95% CI 1.09-1.63]). The number needed to treat/number needed to harm to prevent a CVD or all-cause mortality or to cause type 2 DM in 1 year was 102, 42, and 127, respectively.
Conclusion:
Statins are associated with important reductions in CVD and mortality that outweigh the modest increase in type 2 DM risk in RA patients.
More Related Videos
Related Concept Videos
01:26Atherosclerosis III: Management
01:20Lipid-Lowering Drugs: Statins and Miscellaneous Agents
01:21Rheumatic Heart Disease III: Medical Management
01:26Coronary Artery Disease IV: Preventive Measures
01:30Coronary Artery Disease I: Introduction
01:20Rheumatic Heart Disease IV: Nursing Management