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. Statins - drugs such as atorvastatin (Lipitor) and rosuvastatin (Crestor) that are used to lower cholesterol and manage heart disease - are 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.”
Rheumatoid arthritis (RA) facts
- Rheumatoid arthritis is an autoimmune disease that can cause chronic inflammation of the joints and other areas of the body.
- Rheumatoid arthritis can affect people of all ages.
- The cause of rheumatoid arthritis is not known.
- Rheumatoid arthritis is a chronic disease, characterized by periods of disease flares and remissions.
- In rheumatoid arthritis, multiple joints are usually, but not always, affected in a symmetrical pattern.
- Chronic inflammation of rheumatoid arthritis can cause permanent joint destruction and deformity.
- Damage to joints can occur early and does not correlate with the severity of symptoms.
- The “rheumatoid factor” is an antibody that can be found in the blood of 80% of people with rheumatoid arthritis.
- There is no known cure for rheumatoid arthritis.
- The treatment of rheumatoid arthritis optimally involves a combination of patient education, rest and exercise, joint protection, medications, and occasionally surgery.
- Early treatment of rheumatoid arthritis results in better outcomes
Full citation: “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).
Who Gets rheumatoid arthritis
An estimated 1.3 million people in the United States have RA - that’s almost 1 percent of the nation’s adult population. There are nearly three times as many women as men with the disease. In women, rheumatoid arthritis most commonly begins between the ages of 30 and 60. It often occurs later in life for men. However, even older teens and people in their 20s can get RA. As many as 300,000 children are diagnosed with a distinct but related form of inflammatory arthritis called juvenile arthritis. The disease occurs in all ethnic groups and in every part of the world.
The cause of rheumatoid arthritis is not yet known. Most scientists agree that a combination of genetic and environmental factors is responsible. Researchers have identified genetic markers that cause a tenfold greater probability of developing rheumatoid arthritis. These genes are associated with the immune system, chronic inflammation or the development and progression of RA. Still, not all people with these genes develop rheumatoid arthritis and not all people with the disease have these genes.
Researchers are also investigating infectious agents, such as bacteria or viruses, which may trigger the disease in someone with a genetic propensity for it. Other suspects include female hormones (70 percent of people with RA are women) and the body’s response to stressful events such as physical or emotional trauma. Smoking may also play a role - it not only boosts the risk of developing RA among people with a specific gene, it can also increase the disease’s severity and reduce the effectiveness of treatment.
Research that deepens our understanding of these genes and other factors that may lead to the development of RA is ongoing.
About the Journal:
Arthritis Care & Research is an official journal of the American College of Rheumatology (ACR), and the Association of Rheumatology Health Professionals (ARHP), a division of the College. Arthritis Care & Research is a peer-reviewed research publication that publishes both original research and review articles that promote excellence in the clinical practice of rheumatology. Relevant to the care of individuals with arthritis and related disorders, major topics are evidence-based practice studies, clinical problems, practice guidelines, health care economics, health care policy, educational, social, and public health issues, and future trends in rheumatology practice. The journal is published by Wiley-Blackwell on behalf of the American College of Rheumatology (ACR).
Wiley-Blackwell is the international scientific, technical, medical, and scholarly publishing business of John Wiley & Sons, with strengths in every major academic and professional field and partnerships with many of the world’s leading societies. Wiley-Blackwell publishes nearly 1,500 peer-reviewed journals and 1,500+ new books annually in print and online, as well as databases, major reference works and laboratory protocols.