Impact of statin discontinuation on mortality in patients with rheumatoid arthritis - A population-based study
Arthritis Care & Research , 04/30/2012
De Vera MA et al. – These population–based data indicate that statin discontinuation in rheumatoid arthritis (RA) patients is associated with increased risk of death from cardiovascular disease and all causes. Findings provide support for the importance of compliance with therapy in RA patients who are prescribed statins.Methods
- The authors conducted a population–based longitudinal study of RA patients with incident statin use followed from 1996 to 2006 using administrative health data.
- Statin discontinuation was defined as persistent non–use ≥3 months during therapy course.
- Primary outcomes were mortality from all cardiovascular diseases (CVD mortality) and secondary outcomes were deaths from all causes (all cause mortality).
- Cox's proportional hazards models, with statin discontinuation as a time–dependent variable, were used and multivariable models were adjusted for age, sex, comorbidities and risk factors for mortality, and proxy indicators of RA severity.
- Over 16,144 person–years of follow–up in the cohort of 4,102 incident statin users, they documented 198 deaths due to CVD and 467 deaths overall.
- Adjusted hazard ratios (HR) for the association of statin discontinuation with death were 1.60 (95% CI: 1.15–2.23) for CVD mortality and 1.79 (95% CI: 1.46–2.20) for all cause mortality.
- The association between statin discontinuation and mortality outcomes was not modified by timing of first statin prescription, age, and sex (p–values for interaction: >0.29).