New data on the advantages and disadvantages of statins for patients with rheumatoid arthritis showed significant reductions in cardiovascular and all-cause mortality but an increased risk for type 2 diabetes mellitus. Not all outcomes were equivalent to those known for the general population. In light of the increased risk for mortality, cardiovascular disease, and type 2 diabetes mellitus (T2DM) for patients with rheumatoid arthritis (RA), the risk/benefit profile of statin medication is essential. However, unlike for the general population, data on the T2DM risk associated with statin use is still limited in patients with RA. “As we know, type 2 diabetes is an important concern in RA, because it not only increases and worsens cardiovascular outcomes, but also some infection and cancer incidences and outcomes that are other causes of mortality in RA,” underlined Dr. Gulsen Ozen (University of Nebraska Medical Center). To assess this question, researchers performed an observational study, utilizing three large databases: UK Clinical Practice Research Datalink, Hospital Episode Statistics, and Office of National Statistics.1 Included were 1,768 statin initiators and 3,528 matched non-users for cardiovascular disease and all-cause mortality, along with 3,608 statin users and 7,208 propensity-matched non-users for T2DM in RA. The mean age within the cohorts was about 65, and the mean duration of RA was 4-5 years. In the entire cohort, statin use was significantly linked to a decrease of 32% in cardiovascular events and a 54% decrease in all-cause mortality but a 33% elevated risk of T2DM. “We assessed patients with or without cardiovascular disease, and we found that both groups had similar cardiovascular event reduction, all-cause mortality reduction, and T2DM risk increase with statins,” said Dr. Ozen. “However, only the diabetes risk significantly increased in patients without prior vascular disease.” Of note, the statin-induced cardiovascular disease risk reduction in RA was similar. Still, the reduction in all-cause mortality was more remarkable in RA patients than in the general population. “Given that statins are still underutilized in patients with RA, our findings emphasize the statin initiation in eligible patients with monitoring for T2DM while on treatment,” noted Dr. Ozan. “As statins may have potential pleotropic and anti-inflammatory effects, they may be offering further benefits on other causes of mortality in RA.”
- Ozen G. Reduction of cardiovascular disease and mortality versus risk of new onset diabetes with statin use in patients with rheumatoid arthritis. Abstract 1427, ACR Convergence 2021, 3-10. November.
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