Statin Use in Patients With RA to Reduce CVD, Type 2 Diabetes Risk

Individuals with rheumatoid arthritis (RA) have a high risk of developing cardiovascular disease (CVD) and type 2 diabetes (T2D) due to the chronic inflammation associated with the disease. Although there have been treatment advancements for patients with RA, little is known about how to reduce the risk of CVD and T2D for this patient population.

Given that statins are used to improve CVD outcomes, a group of researchers, led by Gulsen Ozen, MD, investigated the impact of statins on CVD and T2D risk in patients with RA. Consultant360 sat down with Dr Ozen, a rheumatologist at the University of Nebraska Medical Center, to discuss her team’s study and its implications.

Consultant360: How did this research question come about?

Gulsen Ozen, MD: We know that statins have been extensively studied in the general population. However, our understanding of statins’ effects on patients with RA is limited and mostly based on a few studies. Statins also have been shown to have some anti-inflammatory effects. Given that patients with RA are already at higher risk for CVD and T2D than the general population due to chronic inflammation and partly glucocorticoid use, we wanted to assess how statins affect both mortality and T2D risks in patients with RA. This is also a follow-up study to our group’s prior research, in which we showed an increased T2D risk with statins in patients with RA. We wanted to confirm our hypothesis that despite the small T2D risk increase with statins, they still have important mortality benefits in patients with RA.

C360: How do your findings contribute to the existing literature about this topic? 

Dr Ozen: Our study supports the existing evidence that statins have significant mortality benefits in patients with RA regardless of pre-existent CVD. As the first to assess the risk-benefit balance of statins in a propensity score-matched large RA cohort, our study also suggests that the CVD and mortality benefits of statins outweigh T2D risk. 

C360: How do the results of the study impact clinical practice from a multidisciplinary approach?

Dr Ozen: Our findings of all-cause and CVD mortality risk reduction outweighing T2D risk have important clinical significance and impact for providers of patients with RA. It has been shown repeatedly that those with RA are less frequently treated with statins than the general population, which is concerning considering that they are at higher risk of CVD. This multi-layered problem includes the providers’ and patients’ perspectives, comorbidities, and medications. Our findings suggest that statins, in addition to lipid reduction, may have other beneficial effects in patient with RA. As rheumatologists, besides optimal disease activity control, we need to work on addressing the traditional CVD risk factors along with the primary care providers of our patients. Our findings emphasize the benefits of statins in patients with RA. We hope our study results encourage primary care providers and rheumatologists to screen for lipid disorders and treat RA patients with statins if eligible.

C360: What is the next step in research on this topic?

Dr Ozen: The next step in our research is to identify other benefits of statins by searching the cause-specific mortality in those with RA. We also plan to assess the impact of new-onset T2D on important outcomes of RA, such as CVD, infections, and cancer.

C360: What are the overall take home messages from today’s conversation? 

Dr Ozen: Statins in patients with RA are associated with significant improvement of CVD and all-cause mortality, which is possibly due to both lipid-lowering and anti-inflammatory properties of statins. These benefits outweigh the small increase in T2D in this patient population. Given that patients with RA are at high risk for CVD with suboptimal traditional CVD risk factor management, this patient population should be screened for lipid disorders and other CVD risk factors and managed according to the guidelines for the general population.

Reference:

Ozen G, Dell’Aniello S, Pedro S, Michaud K, Suissa S. Reduction of cardiovascular disease and mortality versus risk of new-onset diabetes mellitus with statin use in patients with rheumatoid arthritis. Arthritis Care Res. 2023;75(3):597-607. doi:10.1002/acr.24866