Effectiveness of Statins on Total Cholesterol and Cardiovascular Disease and All-cause Mortality in Osteoarthritis and Rheumatoid Arthritis

Abstract

Objective.There is increasing prevalence of hypercholesterolemia among patients with osteoarthritis (OA) and rheumatoid arthritis (RA). We examined the effectiveness of statins on total cholesterol (TC), cardiovascular (CV) morbidity, and mortality in patients with OA or RA.Methods.A population-based cohort study was done using a record-linkage database in Tayside, Scotland. In total, 2024 OA or RA patients who had at least 2 separate TC measurements between 1993 and 2007 were studied. They were categorized into statin-exposed and statin-unexposed groups according to statin use status during followup. The main outcomes were TC concentration change from baseline, CV events, and all-cause mortality during the followup. Multivariate Cox regression models with a time-dependent variable for statins were employed to assess the risk of outcomes.Results.Statin-associated TC concentrations in OA decreased by 15% in patients without CV disease (primary prevention, n = 1269) and 7% in patients with CV disease (secondary prevention, n = 247) from baseline of 5.30 mmol/l and 4.54 mmol/l, respectively. Correspondingly, in RA TC was reduced by 16% (n = 430) and 15% (n = 78) with baselines of 5.54 mmol/l and 4.95 mmol/l. In primary prevention, statins were associated with reduced CV events and all-cause mortality in RA patients [adjusted HR 0.45 (95% CI 0.20–0.98) and 0.43 (95% CI 0.20–0.92), respectively] and all-cause mortality in OA patients [adjusted HR 0.43 (95% CI 0.25–0.72)]. Statins were not associated with reduced risk of CV events or all-cause mortality in the secondary prevention of RA or OA patients [adjusted HR 0.68 (95% CI 0.30–1.54) and 0.52 (95% CI 0.20–1.34) for OA patients, and HR 0.58 (95% CI 0.07–4.79) and 0.79 (95% CI 0.18–3.53) for RA patients].Conclusion.Statins reduced TC concentrations between 7% and 16% in patients with OA or RA. Statins were associated with reduced CV events and mortality in RA and mortality in OA in primary prevention.

Treatment to lipid targets in patients with inflammatory joint diseases in a preventive cardio-rheuma clinic

“…Polypharmacy increases the risk of drug interactions, and may therefore potentially lead to more side effects. We did not observe this in our patients, which fall in line with the recently reported comparable side effects from statins in patients with and without IJD,9 20 although the patients with IJD had somewhat more side effects from the gastrointestinal tract.…”

“…These factors illuminate the difficulties in cardiovascular risk stratification and prevention in IJD patients. Recent published data indicate that the lipid-lowering effect of statins in RA, AS and PsA patients are comparable to non-IJD patients 9 20…”

Application of the European Society of Cardiology, Adult Treatment Panel III and American College of Cardiology/American Heart Association guidelines for cardiovascular risk management in a French cohort of rheumatoid arthritis

“…In the present RA cohort, only 17.7% of patients aged 40 to 65 and 25.8% of patients over the age of 65 received a statin, while [31]. As secondary prevention, the decrease in cholesterol with statins and relapse in MI are identical, regardless of whether or not the patients have RA, and discontinuing statins is accompanied by a high risk of stroke [32,33].…”

Adherence to cardiovascular prevention strategies in patients with rheumatoid arthritis

“…Regarding CV preventive medication in RA, several studies have shown a favourable effect. Statin treatment effectively improves lipid levels in RA patients (5,20) and antihypertensive treatment with angiotensin-converting enzyme (ACE) inhibitors and angiotensin II antagonists effectively lowers blood pressure and improves endothelial function in RA (21)(22)(23). The response to calcium channel and beta blockers is decreased in inflammatory conditions, therefore the effect of these antihypertensives may be attenuated in RA.…”