Patients with rheumatoid arthritis (RA) who discontinue use of statin therapy are at increased risk of death from cardiovascular disease and other causes. According to the findings of a population-based study now available in Arthritis Care & Research, a journal published by Wiley-Blackwell on behalf of the American College of Rheumatology (ACR), RA patients should be advised of the importance of compliance to their statin therapy to reduce cardiovascular disease (CVD) mortality risk.
A report from the World Health Organization (WHO) estimates that RA affects up to one percent of the population in developed countries. Studies have shown that death rates among those with RA are 1.5-fold higher than in the general population, with CVD cited at the leading cause of mortality in this patient group. Statinsdrugs such as atorvastatin (Lipitor) and rosuvastatin (Crestor) that are used to lower cholesterol and manage heart diseaseare a common therapy for RA patients who are at greater risk of heart disease. Previous research reported 38% of RA patients permanently discontinue statin therapy, consequently increasing their heart attack risk by 67%.
"Our study provides evidence of the harmful effects of ceasing statin therapy," said lead author Mary De Vera, Ph.D., with the University of British Columbia School of Population & Public Health and Arthritis Research Centre of Canada. Using data from the British Columbia Ministry of Health records, researchers indentified 37,151 RA patients who received health services between January 1996 and March 2006. Of those with RA there were 4,102 patients who used statins. The team defined statin discontinuation as non-use of the prescribed medication for three months or more, anytime during the course of therapy.
The mean age of the RA group was 67 years, with 60% of the group being women. More than 16,144 person-years of follow-up were recorded for patients using statins, with roughly 45% of statin users discontinuing therapy at least once during the 4-year follow-up period. The authors reported 198 deaths from CVD and 467 deaths overall. Of the CVD deaths, 31% were from heart attacks and 15% from strokes.
Further analysis revealed that statin discontinuation was associated with a 60% increased risk of CVD deaths and 79% for deaths from all causes, which was not moderated by timing of the first statin prescription, age, or gender. "RA patients who discontinue statin therapy are at increased risk of death from cardiovascular disease," concludes Dr. De Vera. "Our study findings emphasize the importance of medication compliance in RA patients who are prescribed statins."
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"Impact of Statin Discontinuation on Mortality in Patients with Rheumatoid Arthritis A Population-Based Study." Mary A. De Vera, Hyon Choi, Michal Abrahamowicz, Jacek Kopec and Diane Lacaille. Arthritis Care & Research; Published Online: March 28, 2012 (DOI: 10.1002/acr.21643).