THU0086 The Survival Impact of Statins in Rheumatoid Arthritis: A General Population-Based Cohort Study. (9th June 2015)

• Record Type: Journal Article
• Authors: Schoenfeld, S.R.; Lu, L.; Rai, S.; Zhang, Y.; Choi, H.K.
• Is Part Of: Annals of the rheumatic diseases. Volume 74(2015)Supplement 2
• Page Start: 223
• Page End: 224
• Publication Date: 2015-06-09
• Subjects: Rheumatism -- Periodicals; 616.723005
• DOI: 10.1136/annrheumdis-2015-eular.4217
• Languages: English
• ISSNs: 0003-4967

Abstract

Abstract : Background: Given their lipid-lowering and anti-inflammatory properties, statins may have dual cardioprotective [1] and anti-rheumatic benefits [2] in rheumatoid arthritis (RA). These effects are expected to confer survival benefits in RA patients, at least similar to those observed in the JUPITER trial [1] among otherwise healthy individuals with low LDL-cholesterol but with elevated hsCRP (i.e., a 20% reduction in overall mortality). However, no relevant data are available in the field. Objectives: To address this knowledge gap, we evaluated the impact of statin initiation on the risk of mortality among RA patients in a general population context. Methods: We conducted an incident user cohort study with time-stratified propensity score matching in a UK general population database. Our primary definition of RA required an RA diagnostic code with at least one use of a DMARD [3]. We compared statin initiators and non-initiators among patients with a new diagnosis of RA between January 2000 and December 2012. The outcome of interest was all-cause mortality. To closely account for confounding by indication and potential calendar-time effects, we employed propensity score-matched cohorts of statin initiators and non-initiators within 1-year cohort accrual blocks. Propensity scores (i.e., the predicted probability of statin initiation) were estimated using 50 variables, including RA duration, demographics, socio-economic status, body mass index, lifestyle factors, comorbidities, medication use, and healthcare utilization. We used Cox proportional hazard models to calculate hazard ratios for mortality. Results: Of 2, 943 statin initiators, 432 died during the follow up period (mean=4.51 years), whereas among 2, 943 matched non-initiators, 513 died during the follow up period (mean = 4.29 years) (Table 1 ). This corresponds to incidence rates of 32.6/1000 person-years (PY) and 40.6/1000 PY in the statin initiator and comparator groups, respectively. The baseline characteristics were well-balanced in the two groups. Statin initiation was associated with a 21% reduction in all-cause mortality (HR 0.79, 95% CI 0.68-0.91) (Figure 1a ). When we defined RA by its diagnosis code alone (not requiring DMARD use), the corresponding HR was 0.81 (95% CI 0.74-0.90). When we compared the unmatched cohorts to examine the effectiveness of our propensity score matching, the statin initiators (n=3, 438) actually showed a 46% higher risk of mortality (HR 1.46, 95% CI 1.28-1.67) than non-initiators (n=3, 438) due to confounding by indication (Figure 1b ). Conclusions: Findings from this general population study indicate that statin initiation is associated with a survival benefit among RA patients, and its magnitude is similar to that shown in the JUPITER trial among non-RA patients [1]. References: The New England Journal of Medicine. 2008. 359(21):2195-2207. Lancet. 2004. 363(9426):2015-2021. Arthritis and Rheumatism. 2008. 59(9):1314-1321. Disclosure of Interest: None declared