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Discontinuing statins linked to increased mortality in rheumatoid arthritis patients

Reuters Health • The Doctor's Channel Daily Newscast

NEW YORK (Reuters Health) – Patients with rheumatoid arthritis (RA) who are prescribed statin therapy for hypercholesterolemia or ischemic heart disease are at increased risk of death from cardiovascular disease or any cause if they stop taking the medication, according to a Canadian study.

The findings “provide support for the importance of compliance with therapy in RA patients who are prescribed statins,” conclude the authors of the report in Arthritis Care & Research online March 29.

Dr. Mary De Vera, with the University of British Columbia School of Population & Public Health in Vancouver, and colleagues note that RA patients are at increased risk for cardiovascular disease and that many are consequently prescribed chronic statin therapy. However, because therapeutic effects are not readily apparent, RA patients often discontinue statins.

The team previously showed that discontinuation was associated with a 67% increased risk of acute MI, and in the current study they examine its impact on mortality.

The investigators used data from a population-based cohort of some 37,000 patients with rheumatoid arthritis in British Columbia followed from 1996 to 2006.

Statins were being taken by 4102 subjects, but 1862 (45.4%) discontinued at least once for 3 months or more, the report indicates. During a mean follow-up of 4 years, there were 198 cardiovascular deaths and 467 deaths from all causes.

On multivariate analysis, statin discontinuation was associated with a significantly increased risk of CVD mortality (adjusted hazard ratio 1.60) and of all-cause mortality (adjusted HR 1.79), the team found.

Modeling statin discontinuation as a time-dependent variable indicated that the risk of cardiovascular death increased by 0.4% with every additional month from discontinuation, the authors calculated.

“The problem of statin discontinuation has become well-recognized over the last decade, with earlier studies demonstrating that in real-life settings, discontinuation of statins is more frequent than in RCTs,” Dr. De Vera and colleagues point out.

They say their findings underline the need for “raising awareness among health professionals and people with RA of the importance of therapy compliance among patients prescribed with statins.”

SOURCE:

Impact of statin discontinuation on mortality in patients with rheumatoid arthritis – A population-based study

Arthritis Care Res 2012.