Cardiovascular benefits from statins outweigh diabetes risk in patients with RA
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The benefits of statin use to prevent cardiovascular disease and mortality in patients with rheumatoid arthritis outweigh the risks for developing type 2 diabetes, according to data presented at ACR Convergence 2021.
Results of the prevalent new-user cohort study showed that statins were associated with a 32% lower risk for CVD and 54% lower risk for all-cause mortality.
“What we wanted to do was take a look at the impact of statin use as far as how well did it protect against cardiovascular disease and hospitalization events, and all-cause and cardiovascular mortality in RA patients, and what were the associations with increased diabetes,” Kaleb Michaud, PhD, professor at University of Nebraska Medical Center, said during a press conference. “Both of these are very important outcomes when it comes to patients with rheumatoid arthritis, and we have seen lots of recommendations for RA patients to be taking statins, and many studies have shown that there is an underuse for that.”
He added that “we wanted to estimate whether the association or risk of diabetes was bad enough that maybe you shouldn't do [that], as far as the overall number needed to harm vs. the number needed to benefit when it comes to hospitalization. This has been shown previously in the general population, but never before in our population, which always seems to be a little bit different when it comes to these associations and outcomes, especially with cardiovascular disease and diabetes.”
The study included people aged 18 years or older with a diagnosis of RA — and no other diagnoses — taking at least one disease-modifying antirheumatic drug between 1989 and 2018. Information was collected from the UK Clinical Practice Research
Datalink, the Hospital Episode Statistics (HES) and Office of National Statistics (ONS) databases. Any patient with previous diabetes and no link to the HES or ONS were excluded from the study.
To determine rates of CVD (myocardial infarction, stroke, hospitalized heart failure, death) and all-cause mortality, researchers followed 1,768 statin users and 3,528 non-users. To assess diabetes incidence, they followed 3,608 statin users and 7,208 non-statin users.
Users and non-users were matched based on age, sex, BMI, smoking status, alcohol use, joint surgeries, prior CVD, hypertension, rheumatic diseases comorbidity index, osteoporosis/fractures, cancer, thyroid disease, chronic liver disease, kidney disease, lung disease and other heart diseases, health care utilization, DMARD use, glucocorticoid use, NSAID use and CVD medications, according to the abstract.
CVD events occurred among 63 statin users compared with 340 non-users (3.0/100 person-years vs. 2.7/100 person-years) and deaths occurred among 62 statin users compared with 525 non-users (2.7/100 patient-years vs. 4.1/100 patient-years).
Type 2 diabetes incidence occurred in 128 statin users vs. 518 non-users (3.0/100 person-years vs. 2.0/100 person-years).
According to Ozen and colleagues, statin use was associated with a 32% reduced rate of CVD (HR = .68;95% CI, .51-.90), a 54% reduced rate of all-cause mortality (HR = .46;95% CI, .35-.60) and a 33% increase in the rate of type 2 diabetes (HR = 1.33; 95% CI, 1.09-1.63). In statin users, reductions in CVD among those with and without prior CVD were similar (36% and 34%), as were reductions in mortality (62% and 54%).
In 1 year, the number needed to treat to prevent a CVD event was 102 and to prevent mortality was 42. In the same period, number needed to harm for new type 2 diabetes was 127.
“We found that statins are associated with important reductions in cardiovascular disease and mortality, which outweigh the modest increase in type 2 diabetes in RA patients,” Michaud said.
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Ozen G. Abstract #1427. Presented at: ACR Convergence 2021; November 5-9, 2021 (virtual meeting).
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