Statins Cut Mortality in Seronegative Spondyloarthropathies

Kate Johnson

November 14, 2016

WASHINGTON, DC — For patients with ankylosing spondylitis or psoriatic arthritis, statins might lower the risk for mortality by up to 32%, according to the results from a population-based study.

The findings suggest that clinicians can consider prescribing statins earlier than they previously have in this patient population, said lead investigator Amar Oza, MD, from the Massachusetts General Hospital in Boston.

"With this amount of mortality benefit, if there are other reasons to start a statin, I certainly would have a lower threshold," he told Medscape Medical News.

The results of the study were presented here at the American College of Rheumatology 2016 Annual Meeting.

The investigators identified people with ankylosing spondylitis and psoriatic arthritis from The Health Improvement Network (THIN) database, which contains data on 11.1 million patients seen in general practice in the United Kingdom.

They used time-stratified propensity score matching to look at all-cause mortality in 2904 patients who initiated statin use and 2904 who did not.

An unmatched analysis, involving 3389 patients who initiated statin use and 3389 who did not, was conducted to demonstrate the validity of propensity score matching.

In the unmatched analysis, baseline differences in age, comorbidities, and cholesterol levels between statin initiators and noninitiators were significant. This translated to a mortality risk that was 44% higher in initiators.

"This confirms our understanding that statins are generally prescribed in sicker patients, who will go on to have a higher cumulative mortality than patients not requiring statin treatment," Dr Oza explained.

However, after propensity score matching, which was aimed at balancing confounders, there were fewer deaths in the statin initiators than in noninitiators during the mean follow-up of 5.3 years (271 vs 376).

This translated to lower incidence rates for statin initiators than for noninitiators (17.6 vs 25.1 per 1000 person-years), and a hazard ratio of 0.68 for all-cause mortality with statin use, Dr Oza reported.

The protective effect of statins only reached statistical significance when patients with ankylosing spondylitis and psoriatic arthritis were combined, not when they were considered separately.

"Numerous studies have shown that we probably undertreat cardiovascular risk in our rheumatic disease patients. This study demonstrates that we can consider statins as a treatment option," said session moderator Joan Von Feldt, MD, from the University of Pennsylvania in Philadelphia.

"If this motivates clinicians to think about cardiovascular disease as an extra-articular manifestation of rheumatic disease, we could have a more appropriate risk management for these patients," she told Medscape Medical News.

Although both rheumatoid arthritis and systemic lupus erythematosus have been shown to be independent risk factors for cardiovascular mortality, to date, neither ankylosing spondylitis nor psoriatic arthritis have been, Dr Von Feldt explained.

"There aren't too many evidence-based guidelines for evaluation of cardiovascular risk in ankylosing spondylitis and psoriatic arthritis," added Dr Oza.

So far, the guidelines have included rheumatoid arthritis in general-population risk calculators, but the actual data for doing that with ankylosing spondylitis and psoriatic arthritis have not been published, he explained.

"I think this is one of the first steps in going down that road and helping these patients," he added.

Dr Oza and Dr Von Feldt have disclosed no relevant financial relationships. Senior study author Hyon Choi, MD, from Massachusetts General Hospital, reports receiving research grants from AstraZeneca for unrelated projects, and acting as a consultant for Takeda Pharmaceuticals and Selecta Biosciences.

American College of Rheumatology (ACR) 2016 Annual Meeting: Abstract 910. Presented November 13, 2016.

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