Statins may lower mortality risk in ankylosing spondylitis patients

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Patients with ankylosing spondylitis or psoriatic arthritis who take statins may have as much as a 33% lower mortality risk, according to new research findings presented at the 2016 American College of Rheumatology Annual Scientific Meeting in Washington, DC.

Researchers at Massachusetts General Hospital in Boston, USA set out to explore the potential benefits of statins, which can both lower lipids and reduce inflammation, in patients with ankylosing spondylitis or psoriatic arthritis. The goal of the study was to see if initiation of statins might be associated with a lower mortality risk in this patient population.

“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,” says Amar Oza, a rheumatologist at Massachusetts General and a lead author of the study along with Na Lu and Hyon Choi. “A randomised trial found such a dual benefit among patients with rheumatoid arthritis, and a population-based study of patients with rheumatoid arthritis 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.”

Using a UK general population database, the researchers studied both ankylosing spondylitis or psoriatic arthritis patients between January 1, 2000 and December 31, 2014. They used 50 different variables to create propensity scores, including disease duration, socioeconomic status, body-mass index, lifestyle factors and medication use. Of 2,904 patients with either condition who started statins, 271 died during the follow-up, a mean of 5.3 years. Of 2,904 propensity-matched patients who did not start statins, 376 died during the follow-up, a mean of 5.15 years. Baseline characteristics between the two groups were well balanced. Statin initiation was associated with 33% reduction in all-cause mortality.

The inverse association of statin initiation and mortality risk among ankylosing spondylitis or psoriatic arthritis patients appears to be larger than that observed in other population-based cohort studies of rheumatoid arthritis patients, the study notes. Statins’ dual benefits of lowering lipids and reducing inflammation, both contributors to cardiovascular disease risk, could be the reason for this significant benefit, the authors speculate.

“Given the increased risk of mortality and cardiovascular disease compared to the general population, patients with seronegative spondyloarthropathies like ankylosing spondylitis or psoriatic arthritis may benefit from the dual anti-inflammatory and lipid-lowering properties of statins, perhaps even more than in the general population,” says 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.”

More research is needed to explore the potential benefits of statins to prevent mortality due to cardiovascular and other causes, he concludes.

The research was supported by funding from the US National Institutes of Health’s National Institute of Arthritis and Musculoskeletal and Skin Diseases.