Pharmacoepidemiologic studies of statins in rheumatoid arthritis

• Main Author: De Vera, Mary Abigail
• Language: English
• Published: University of British Columbia 2010
• Online Access: http://hdl.handle.net/2429/28886

Introduction: This thesis comprises four studies aimed at improving current understanding of statin use in rheumatoid arthritis (RA), a patient population with established CVD risk. There is need for a better understanding of the cardioprotective role of statins in RA through dual lipid-lowering and anti-inflammatory effects. Since deriving therapeutic effect from medication depends not only on physicians prescribing treatment but also on patients’ compliance with therapy, there is also need for better understanding of the impact of statin compliance on relevant outcomes in RA. Objectives: 1) To evaluate whether statin use has a cardioprotective effect among individuals with RA; 2) To synthesize current evidence on adverse outcomes associated with discontinuation of statin therapy; 3) To evaluate the impact of statin discontinuation on risk of acute myocardial infarction (AMI) among RA patients prescribed with statins; and 4) To evaluate the impact of statin discontinuation on risk of mortality among RA patients prescribed with statins. Methods: To address Objectives 1, 3, and 4, I conducted three longitudinal studies of a population-based RA cohort in BC. To address Objective 2, I conducted a systematic review. Results: 1) Statin use is associated with a 31% lower risk of AMI in RA patients; 2) There is a consistent finding of increased risk of adverse outcomes associated with statin discontinuation in different patient populations; highlighting the importance of compliance in patients who are prescribed statins for primary or secondary prevention; 3) Discontinuation of statin therapy is associated with a 67% increased risk of AMI among patients with RA; 4) Discontinuation of statin therapy is associated with 60% and 79% increased risk of cardiovascular disease mortality and all-cause mortality, respectively, in patients with RA. Conclusion: Altogether as a collective work, this thesis provides supporting evidence for a substantial role of statins in management of CVD, a key comorbidity in RA, and additionally highlights the importance of patient compliance with statin therapy in achieving therapeutic goals of treatment.