Arthritis & Rheumatism, Volume 63,
November 2011 Abstract Supplement

Abstracts of the American College of
Rheumatology/Association of Rheumatology Health Professionals
Annual Scientific Meeting
Chicago, Illinois November 4-9, 2011.


Statin Use Is Associated with Decreased Incident Coronary Artery Events in Rheumatoid Arthritis Patients.

Walker1,  Chad P., Tang2,  Xiaoqin, Kirchner2,  H. Lester, Steinhubl3,  Steven, Morris4,  Stephanie J., Antohe3,  Jana L., Bili5,  Androniki

Geisinger, Bloomsburg, PA
Geisinger Center for Health Research, Danville, PA
Geisinger Health System, Danville, PA
Rose Tree Medical Associates—Riddle Memorial Hos, Danville, PA
Geisinger Medical Center, Danville, PA

Background/Purpose:

Rheumatoid arthritis (RA) is associated with increased morbidity and mortality from cardiovascular disease (CVD). Statins have been associated with decreased coronary artery disease (CAD) events in the general population and have immunomodulatory effects, but this relationship has not been studied in RA. We examined the association of statin use with incident CAD in an inception cohort of RA patients.

Methods:

Patients with newly diagnosed RA between 1/1/2001–12/31/2009 were identified through electronic health records (n=1881). Patients with preexisting CVD (CAD, cardiac revascularization procedure, abdominal aortic aneurysm, stroke, transient ischemic attack, peripheral artery disease, arterial revascularization procedure), primary care physician outside the institution, previous statin use or liver disease were excluded (n=1331). The primary outcome was time to CAD (ICD-9 code ICD-9 410, 410.**-414.99 or revascularization procedure CPT codes 33510, 33548, 92982, 92984, G0290, G0291, 92930, 92981). Secondary analysis used time to development of CVD. Cox regression models were used to estimate the association between exposure to statin use and development of disease after adjusting for age, gender, race, hypertension, hyperlipidemia, diabetes, body mass index, low density lipoprotein level, systolic and diastolic blood pressure, rheumatoid factor, sedimentation rate and medications (TNF inhibitors, MTX, HCQ, steroids and NSAIDs).

Results:

Analyses included 550 RA patients. Table 1 shows the patients' characteristics by statin use. Of the 39 cases developing CAD during observation, 14 were ever- and 35 were never-statin users. The median duration of statin exposure was 17.3 months. Of the 14 cases developing CAD in statin ever-users, 7 were exposed <= 17 months and 7 were exposed >17 months. The incidence rate ratio (95% CI) for statin use >17 months vs. <= 17 months vs. statin never use was 0.87 (0.39, 1.95; p-value=0.74) and 2.03 (1.06, 3.88; p-value=0.03) compared to never-use respectively. Results of the fully adjusted Cox model are shown in Table 2.

Table 1. Characteristics of RA patients by Duration of Statin Usage

 Post-RA Statin use1P-value*
Never (n = 432)<=17 month (n = 58)>17 month (n = 60) 
Male sex105 (24.3%)14 (24.1%)16 (26.7%)n.s.
White race411 (95.1%)54 (93.1%)58 (96.7%)n.s.
Positive CCP IgG Ab126 (54.3%)16 (57.1%)10 (45.5%)n.s.
Positive rheumatoid factor272 (76.4%)36 (80.0%)41 (82.0%)n.s.
Medication use (ever)    
TNF139 (32.2%)24 (41.4%)21 (35.0%)n.s.
Hydroxychloroquine185 (42.8%)23 (39.7%)24 (40.0%)n.s.
Methotrexate256 (59.3%)37 (63.8%)41 (68.3%)n.s.
NSAIDs331 (76.6%)52 (89.7%)50 (83.3%).049
Steroid377 (87.3%)49 (84.5%)55 (91.7%)n.s.
Hypertension227 (52.6%)43 (74.1%)48 (80.0%)<.001
Hyperlipidemia16 (3.7%)49 (84.5%)54 (90.0%)<.001
DM67 (15.5%)20 (34.5%)30 (50.0%)<.001
Age at RA diagnosis54 (44, 67)59 (53, 68)58 (52, 71).002
Median BMI (95.3% known)28.4 (24.4, 32.3)30.3 (27.6, 35)32.1 (28.2, 36.2)<.001
Median LDL (77.3% known)107 (89, 128)123 (102, 142)103 (82, 120).001
Median SBP74 (70, 80)76.5 (72, 80)72 (70, 80).047
Median DBP124 (118, 132)130 (122, 134)131 (123, 139)<.001
Pt Max CRP result (35.8% known)**6.9 (2.4, 19)7.4 (3.2, 19.7)7.8 (3.1, 19.8)n.s.
Pt Max Sedimentation Rate (81.3% known)30 (16, 50)34 (20, 54)46 (21, 77).024
1. Ever Post-RA statin usage prior to DM diagnosis or censor date.
* P-values obtained either from Chi-square tests (frequencies) or Wilcoxon's test (medians)
** Not included in modeling due to the high percentage of missing data.
̂ These are ever in time-frame. All else are post-RA.
n.s. = not significant

Table 2. Risk of developing CAD and CVD Based on Statin Use in RA patients

   HR (95% CI)p-value
Coronary Artery DiseaseCumulative duration of statin exposureContinuous (in months)0.96 (0.96, 0.99).009
 Cumulative duration of statin exposure<=17 months vs. never use1.12 (0.42, 2.97)n.s.
  >17 months vs. never use0.30 (0.10, 0.94).039
Cardiovascular DiseaseCumulative duration of statin exposureContinuous (in months)0.97 (0.98, 0.10).021
 Cumulative duration of statin exposure<=17 months vs. never use1.52 (0.69, 3.31)n.s.
  >17 months vs. never use0.45 (0.16, 1.25)n.s.
Coronary Artery Disease*Cumulative duration of statin exposureContinuous (in months)0.963 (0.935, 0.991).009
 Cumulative duration of statin exposure<=17 months vs. never use1.121 (0.423, 2.974)n.s.
  >17 months vs. never use0.303 (0.098, 0.940).039
Cardiovascular Disease*Cumulative duration of statin exposureContinuous (in months)0.971 (0.947, 0.996).021
 Cumulative duration of statin exposure<=17 months vs. never use1.515 (0.694, 3.306)n.s.
  >17 months vs. never use0.445 (0.159, 1.246)n.s.
* Fully adjusted using time-variance where applicable for age, gender, race, hypertension, hyperlipidemia, diabetes, body mass index, low density lipoprotein level, systolic and diastolic blood pressure, rheumatoid factor, sedimentation rate and medications (TNF inhibitors, MTX, HCQ, steroids and NSAIDs)
n.s. = not significant

Conclusion:

Statin use was associated with a 4% per month decrease in incident CAD risk in RA patients. For RA patients using statins for >17 months the risk of incident CAD decreased by 70%. Secondary analysis for incident CVD showed similar trends, although this did not reach statistical significance. This is a novel finding that may allow the study of statin use for primary CAD prevention in RA patients.

To cite this abstract, please use the following information:
Walker, Chad P., Tang, Xiaoqin, Kirchner, H. Lester, Steinhubl, Steven, Morris, Stephanie J., Antohe, Jana L., et al; Statin Use Is Associated with Decreased Incident Coronary Artery Events in Rheumatoid Arthritis Patients. [abstract]. Arthritis Rheum 2011;63 Suppl 10 :1160
DOI:

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