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Statins protective against myocardial infarction in SLE
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DESTIN, Fla. — Statins demonstrate a protective effect in patients with systemic lupus erythematosus regardless of cardiovascular disease risk factors, according to a data presented at the North American Young Rheumatology Investigator Forum.
“Numerous clinical trials and analyses have demonstrated that statin therapy without established cardiovascular disease, but with significant risk factors, has reduced the risk for major cardiovascular events and has improved overall survival,” Yael Klionsky, MD, of the Case Western Reserve University MetroHealth System, told attendees. “In patients with autoimmune conditions, statins have demonstrated clinical efficacy in modulating vascular risk factors, specifically by limiting anti-inflammatory effects as measured by both clinical and laboratory exam findings.”
“Furthermore, studies have suggested that statin use reduces both morbidity and mortality in SLE patients with hyperlipidemia,” she added. “However, to date, there is no large database study evaluating specific cardiovascular risk factors and statin use in SLE patients.”
To analyze the risk for cardiovascular disease events in relation to statin use among patients with SLE, and to determine the influence of statins on myocardial infarction, Klionsky and colleagues conducted a retrospective cohort study using the Explorys Inc. health database. According to the researchers, Explorys aggregates and de-identifies a large population of patient data from medical records across multiple health systems. As of March 2019, they had analyzed data from more than 61 million patients throughout the United States.
The researchers identified patients with SLE through diagnosis codes with a prescription for hydroxychloroquine, in combination with positive anti-nuclear antibodies or double-stranded DNA. Myocardial infarction was defined as either any abnormal troponin or through diagnosis codes. The researchers identified statin therapy through the prescription of any dose of any HMG-CoA reductase inhibitor. Patients with rheumatoid arthritis and malaria were excluded. The researchers used a chi-square test to analyze the effects of statin on myocardial infarction risk.
In addition, the researchers evaluated all known cardiovascular risk factors, comparing patients who used statins with those who did not use statins, using the Wilcoxon-Signed Rank test. Each risk factor was tested alongside the use of statins to analyze whether there was any significant effect on the risk for myocardial infarction. The researchers identified 20,540 patients treated with statins, and 16,680 who did not use statins.
According to Klionsky, there were 13,190 occurrences of myocardial infarction among patients who were prescribed statins, compared with 15,340 among nonusers, with a relative risk for myocardial infarction with statin use of 0.82 (P < .001). In addition, the researchers found that of the analyzed cardiac risk factors, including hypertension, obesity, tobacco use and abnormal cholesterol, none had a significant impact on the risk for myocardial infarction compared with statin use (P < .001).
“To date, this is the largest retrospective study evaluating the effects of statin therapy on myocardial infarction risk in the SLE population,” Klionsky said. “Myocardial infarctions, we found, are more prevalent in SLE patients not on statin therapy. As such, the relative risk for myocardial infarction is less with SLE patients on statin therapy. When evaluating other known cardiovascular risk factors within this high-risk population, statins still contribute the greatest effect in decreasing overall myocardial infarction risk.” – by Jason Laday
Reference:
Klionsky Y. Statin therapy in systemic lupus erythematosus (SLE) patients: Cross-sectional analysis of a large population database. Presented at: North American Young Rheumatology Investigator Forum; May 1, 2019; Destin, Fla.
Disclosure: Klionsky reports no relevant financial disclosures.