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The Effect of Statin Use on Mortality in Systemic Autoimmune Rheumatic Diseases

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Jorge AM1, Lu N1, Keller SF1, Rai SK1, Zhang Y1, Choi HK1. J Rheumatol. 2018 Sep 1. pii: jrheum.171389. doi: 10.3899/jrheum.171389. [Epub ahead of print]

Abstract

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1 From the Division of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA. This project was supported in part by the Ruth L. Kirschstein Institutional National Research Service Award T32-AR-007258 and National Institutes of Health Grant P60-AR-047785. A.M. Jorge, MD, Graduate Assistant, Research Fellow, Massachusetts General Hospital, and Harvard Medical School; N. Lu, MPH, Research Assistant, Massachusetts General Hospital; S.F. Keller, MD, Rheumatology Fellow, Research Fellow, Massachusetts General Hospital, and Harvard Medical School; S.K. Rai, MSc, Research Assistant, Massachusetts General Hospital; Y. Zhang, DSc, Faculty, Harvard Medical School; H.K. Choi, MD, PhD, Professor, Harvard Medical School. Address correspondence to Dr. A.M. Jorge, Division of Rheumatology, Allergy, and Immunology, Department of Medicine, Massachusetts General Hospital, 55 Fruit St., Bulfinch 165, Boston, Massachusetts 02114, USA. E-mail: AMJorge@mgh.harvard.edu. Accepted for publication May 11, 2018.

Abstract

OBJECTIVE: Systemic autoimmune rheumatic diseases (SARD) are associated with an increased risk of premature cardiovascular disease (CVD) and all-cause mortality. We examined the potential survival benefit of statin use among patients with SARD in a general population setting.

METHODS: We conducted an incident user cohort study using a UK general population database. Our population included patients with a SARD as determined by Read code diagnoses of systemic lupus erythematosus, systemic sclerosis, Sjögren syndrome, dermatomyositis, polymyositis, mixed connective tissue disease, Behçet disease, or antineutrophil cytoplasmic antibodies-associated vasculitis between January 1, 2000, and December 31, 2014. We compared propensity score-matched cohorts of statin initiators and noninitiators within 1-year cohort accrual blocks to account for potential confounders, including disease duration, body mass index, lifestyle factors, comorbidities, and medication use.

RESULTS: Of 2305 statin initiators, 298 died during the followup period (mean 5.1 yrs), whereas among 2305 propensity score-matched noninitiators, 338 died during the followup period (mean 4.8 yrs). This corresponded to mortality rates of 25.4/1000 and 30.3/1000 person-years, respectively. Statin initiation was associated with reduced all-cause mortality (HR 0.84, 95% CI 0.72-0.98). When we compared the unmatched cohorts, the statin initiators (n = 2863) showed increased mortality (HR 1.85, 95% CI 1.58-2.16) compared with noninitiators (n = 2863 randomly selected within 1-year cohort accrual blocks) because of confounding by indication.

CONCLUSION: In this general population-based study, statin initiation was shown to reduce overall mortality in patients with SARD after adjusting for relevant determinates of CVD risk.