Researchers at Massachusetts General Hospital have new evidence that patients with ankylosing spondylitis (AS) or psoriatic arthritis (PsA) who take statins may have as much as a 33% lower mortality risk.
“The expanding literature on the dual-role of statins to lower both inflammation and cholesterol levels has naturally led to interest in the role of statins in inflammatory arthritis, ” said Amar Oza, M.D. in the November 12, 2016 news release. Dr. Oza is a rheumatologist at Massachusetts General and a lead author of the study along with Na Lu, M.D. and Hyon Choi, M.D. “A randomized trial found such a dual benefit among patients with rheumatoid arthritis (RA), and a population-based study of patients with RA found a survival benefit associated with statin use as well. As such, we hoped to quantify the potential impact of statins in the seronegative spondyloarthropathies, as the risk of all-cause mortality and even cardiovascular-specific mortality has shown to be elevated in these conditions.”
“Given the increased risk of mortality and cardiovascular disease compared to the general population, patients with seronegative spondyloarthropathies like AS and PsA may benefit from the dual anti-inflammatory and lipid-lowering properties of statins, perhaps even more than in the general population, ” said Dr. Oza. “This observational study raises the possibility that clinicians may have a lower threshold for starting their patients on statins to mitigate this mortality risk. To that effect, it sets the groundwork for potential clinical trials to come, which will provide high-level evidence about the impact statins have on their health.”
Dr. Oza told OTW, “Our study was entitled the ‘Survival Benefit of Statin Use in Ankylosing Spondylitis and Psoriatic Arthritis.’ We conducted an incident-user cohort study using time-stratified propensity score matching that compared AS and PsA patients that were statin initiators to non-initiators. Our study, with a mean follow up time over 5 years, showed a mortality benefit of 32% and a statistically significant hazard ratio of 0.68. This suggests that statins may be beneficial in this patient population to lower the risk of all-cause mortality. Furthermore, the magnitude of this mortality reduction is larger than large meta-analyses of the general population (on the order of 9-14%).”
“Orthopedic surgeons are very knowledgeable about perioperative care and outcomes research. In ankylosing spondylitis and psoriatic patients, statins can potentially be very helpful in lowering the risk of all-cause mortality, but prior data has also shown a modest anti-inflammatory effect in these diseases.”
“In our study, I found the magnitude of the mortality reduction, especially in our ankylosing spondylitis patients, to be the most interesting. With an all-cause mortality reduction more than double that seen in the general population, I feel this finding serves as a jumping off point for additional studies to characterize the role of statins in these diseases.
“We are further planning to investigate the role of statin initiation in ankylosing spondylitis patients alone, as the mortality reductions seen in our analysis seem to have been driven predominantly by these patients. The findings of our study need to be replicated in different patient populations to determine the true benefits of statins in this disease and potentially affect our clinical practice going forward.”
