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

doi:10.3899/jrheum.171389

. 2018 Dec;45(12):1689-1695.

doi: 10.3899/jrheum.171389. Epub 2018 Sep 1.

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

April M Jorge^{1

2}, Na Lu^{3

4}, Sarah F Keller^{3

4}, Sharan K Rai^{3

4}, Yuqing Zhang^{3

4}, Hyon K Choi^{3

4}

Affiliations

¹ From the Division of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA. AMJorge@mgh.harvard.edu.
² 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. AMJorge@mgh.harvard.edu.
³ From the Division of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA.
⁴ 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.

PMID: 30173155
PMCID: PMC6289699
DOI: 10.3899/jrheum.171389

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

April M Jorge et al. J Rheumatol. 2018 Dec.

. 2018 Dec;45(12):1689-1695.

doi: 10.3899/jrheum.171389. Epub 2018 Sep 1.

Authors

April M Jorge^{1

2}, Na Lu^{3

4}, Sarah F Keller^{3

4}, Sharan K Rai^{3

4}, Yuqing Zhang^{3

4}, Hyon K Choi^{3

4}

Affiliations

¹ From the Division of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA. AMJorge@mgh.harvard.edu.
² 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. AMJorge@mgh.harvard.edu.
³ From the Division of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA.
⁴ 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.

PMID: 30173155
PMCID: PMC6289699
DOI: 10.3899/jrheum.171389

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.

Keywords: EPIDEMIOLOGY; MORTALITY; PREVENTIVE MEDICINE; RHEUMATIC DISEASES; SYSTEMIC LUPUS ERYTHEMATOSUS.

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Conflict of interest statement

Disclosure statement: We have no relevant conflicts of interest to disclose.

Figures

**Figure 1**
Cumulative Mortality over Time in Statin Initiators and Non-Initiators

See this image and copyright information in PMC

Comment in

Statins and Mortality in Connective Tissue Diseases: Should We Resume the Cardio-rheumatology Spirit in Our Clinics?
Gremese E, DE Lorenzis E, Ferraccioli GF. Gremese E, et al. J Rheumatol. 2018 Dec;45(12):1617-1619. doi: 10.3899/jrheum.180732. J Rheumatol. 2018. PMID: 30504479 No abstract available.

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References

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[1] Prasad M, Hermann J, Gabriel SE, Weyand CM, Mulvagh S, Mankad R, et al. Cardiorheumatology: cardiac involvement in systemic rheumatic disease. Nat Rev Rheumatol. 2015;12:168–76. - PMC - PubMed

[2] Prasad M, Hermann J, Gabriel SE, Weyand CM, Mulvagh S, Mankad R, et al. Cardiorheumatology: cardiac involvement in systemic rheumatic disease. Nat Rev Rheumatol. 2015;12:168–76. - PMC - PubMed

[3] Bernatsky S, Linehan T, Hanly JG. The accuracy of administrative data diagnoses of systemic autoimmune rheumatic diseases. J Rheumatol. 2011;38:1612–6. - PubMed

[4] Bernatsky S, Linehan T, Hanly JG. The accuracy of administrative data diagnoses of systemic autoimmune rheumatic diseases. J Rheumatol. 2011;38:1612–6. - PubMed

[5] Breunig M, Kleinert S, Lehmann S, Kneitz C, Feuchtenberger M, Tony HP, et al. Simple screening tools predict death and cardiovascular events in patients with rheumatic disease. Scand J Rheumatol. 2017:1–8. - PubMed

[6] Breunig M, Kleinert S, Lehmann S, Kneitz C, Feuchtenberger M, Tony HP, et al. Simple screening tools predict death and cardiovascular events in patients with rheumatic disease. Scand J Rheumatol. 2017:1–8. - PubMed

[7] Bartoloni E, Alunno A, Gerli R. Hypertension as a cardiovascular risk factor in autoimmune rheumatic diseases. Nat Rev Cardiol. 2017 - PubMed

[8] Bartoloni E, Alunno A, Gerli R. Hypertension as a cardiovascular risk factor in autoimmune rheumatic diseases. Nat Rev Cardiol. 2017 - PubMed

[9] Bartoloni E, Shoenfeld Y, Gerli R. Inflammatory and autoimmune mechanisms in the induction of atherosclerotic damage in systemic rheumatic diseases: two faces of the same coin. Arthritis Care Res (Hoboken) 2011;63:178–83. - PubMed

[10] Bartoloni E, Shoenfeld Y, Gerli R. Inflammatory and autoimmune mechanisms in the induction of atherosclerotic damage in systemic rheumatic diseases: two faces of the same coin. Arthritis Care Res (Hoboken) 2011;63:178–83. - PubMed

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

Affiliations

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

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Abstract

Conflict of interest statement

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