Statins show CVD benefits in RA with only a modest risk for new-onset diabetes
medwireNews: Statins may help to reduce the risk for cardiovascular disease (CVD) and mortality in patients with rheumatoid arthritis (RA) without majorly increasing the risk for diabetes, research suggests.
The study included 16,112 participants, identified from the UK Clinical Practice Research Datalink, who were all aged over 18 years and had RA with no alternative diagnoses and were prescribed at least one DMARD between 1989 and 2018.
Among these individuals, first-time statin users were matched to non-users with time conditional propensity scores to balance baseline characteristics. The Hospital Episode Statistics and Office of National Statistics databases were then used to calculate incidence of CVD events, comprising a composite of nonfatal or fatal myocardial infarction, stroke, hospitalization for heart failure, or death from CVD, and all-cause mortality in one cohort of 1768 RA patients taking statins and 3528 patients not taking statins.
Presenting the findings at the ACR Convergence 2021 virtual meeting, Gulsen Ozen (University of Nebraska Medical Center, Omaha, USA) reported a 32% reduction in the risk for CVD outcomes and a 54% reduction in all-cause mortality among the RA patients taking statins versus those not taking statins.
The reductions in CVD and all-cause mortality risk with statins were seen in men and women and those with and without prior CVD, reaching statistical significance for all groups with the exception of CVD in men, which Ozen said is likely to due to the small sample size.
These benefits were seen alongside a 33% significantly increased risk for type 2 diabetes in a second cohort of 3608 RA patients starting statins who were compared with 7208 matched patients not taking statins.
“Statins were associated with important reductions in CVD and all-cause mortality both in primary and secondary CVD prevention, which outweighed the modest type 2 diabetes risk increase in RA patients,” Ozen commented.
The risk for type 2 diabetes was increased in all groups, but only significantly so among women and those with no prior CVD.
The findings showed that 102 patients would need to be treated with statins for 1 year to prevent one CVD event and 42 to prevent one death, while 127 patients would need to be treated with statins for 1 year for a new diagnosis of type 2 diabetes to occur.
The relative effect of statins on CVD risk reduction in RA patients was similar to that seen in the general population, she noted, and greater for the reduction in death from any cause. And this was balanced against a risk for types 2 diabetes that was no greater than that for the general population.
“Given that statins are still underutilized in patients with RA, our findings emphasize statin initiation in eligible RA patients with monitoring for Type 2 diabetes while on treatment,” Ozen said.
She continued: “As statins may have potential pleiotropic and anti-inflammatory effects, they may be offering further benefits on other causes of mortality in RA,” but she noted that the study had no or limited data on RA disease activity and the use of biologic DMARDs.
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