Statin reduces mortality and morbidity in systemic lupus erythematosus patients with hyperlipidemia: A nationwide population-based cohort study

Atherosclerosis. 2015 Nov;243(1):11-8. doi: 10.1016/j.atherosclerosis.2015.08.030. Epub 2015 Aug 28.


Objective: The anti-inflammatory and cardiovascular protective effects of statin for patients with systemic lupus erythematosus (SLE) are not clear. We tested the hypothesis that statin use is associated with reduced mortality and morbidity in SLE patients with hyperlipidemia.

Methods: We included 4095 patients with SLE and hyperlipidemia from the entire population using the Taiwan National Health Insurance Research Database between 1997 and 2008. A total of 935 matching sets (1:2) of patients who had never used lipid-lowering medications and statin users were included in the nested matched cohort. Cox proportional hazards regression was used to calculate the hazard ratios (HR) and 95% confidence intervals (CI) for the association between statin and all-cause mortality, coronary artery disease (CAD), cerebrovascular disease (CVD) and end-stage renal disease (ESRD), conditional for matching sets in the matched cohort.

Results: The multivariate adjusted hazard ratios (HR) for statin users, as compared with patients had never used lipid-lowering medications, were 0.67 (95% CI, 0.54 to 0.83) for death from any cause. High-dose statins (>365 cumulative defined daily dose) significantly reduced risk of all-cause mortality (HR 0.44, 95% CI 0.32 to 0.60); CAD (HR 0.20, 95% CI 0.13 to 0.31); CVD (HR 0.14, 95% CI 0.08 to 0.25); and ESRD (HR 0.22, 95% CI, 0.16 to 0.29), with similar results in the nested matched study.

Conclusion: Statin therapy in SLE patients with hyperlipidemia may reduce the risk of mortality, cardiovascular disease and ESRD. The effect of statins needs to be demonstrated in large prospective studies with long-term follow-up.

Keywords: Cardiovascular disease; Epidemiology; Mortality; Statin; Systemic lupus erythematosus.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Anti-Inflammatory Agents / therapeutic use
  • Cerebrovascular Disorders / complications
  • Cerebrovascular Disorders / drug therapy
  • Cerebrovascular Disorders / mortality
  • Cohort Studies
  • Coronary Artery Disease / complications
  • Coronary Artery Disease / drug therapy
  • Coronary Artery Disease / mortality
  • Dose-Response Relationship, Drug
  • Female
  • Humans
  • Hydroxymethylglutaryl-CoA Reductase Inhibitors / therapeutic use*
  • Hyperlipidemias / complications*
  • Hyperlipidemias / drug therapy
  • Hyperlipidemias / mortality
  • Immunologic Factors / therapeutic use
  • Kidney Failure, Chronic / complications
  • Kidney Failure, Chronic / drug therapy
  • Kidney Failure, Chronic / mortality
  • Lupus Erythematosus, Systemic / complications*
  • Lupus Erythematosus, Systemic / mortality
  • Male
  • Middle Aged
  • Multivariate Analysis
  • Proportional Hazards Models
  • Registries
  • Regression Analysis
  • Reproducibility of Results
  • Taiwan


  • Anti-Inflammatory Agents
  • Hydroxymethylglutaryl-CoA Reductase Inhibitors
  • Immunologic Factors