title: Impact of statin discontinuation on mortality in patients with rheumatoid arthritis: a population-based study.
abstract: OBJECTIVE
  To evaluate the impact of statin discontinuation on cardiovascular disease (CVD) mortality and all-cause mortality in a population-based cohort of patients with rheumatoid arthritis (RA).
  
  
  METHODS
  We conducted a population-based longitudinal study of RA patients with incident statin use followed from 1996 to 2006 using administrative health data. Statin discontinuation was defined as persistent nonuse for ≥3 months during the therapy course. Primary outcomes were mortality from all CVDs (CVD mortality) and secondary outcomes were deaths from all causes (all-cause mortality). Cox proportional hazards models with statin discontinuation as a time-dependent variable were used and multivariable models were adjusted for age, sex, comorbidities, and risk factors for mortality, and proxy indicators of RA severity.
  
  
  RESULTS
  Over 16,144 person-years of followup in the cohort of 4,102 incident statin users, we documented 198 deaths due to CVD and 467 deaths overall. Adjusted hazard ratios for the association of statin discontinuation with death were 1.60 (95% confidence interval [95% CI] 1.15-2.23) for CVD mortality and 1.79 (95% CI 1.46-2.20) for all-cause mortality. The association between statin discontinuation and mortality outcomes was not modified by timing of the first statin prescription, age, and sex (P values for interaction ≥0.29).
  
  
  CONCLUSIONS
  These population-based data indicate that statin discontinuation in patients with RA is associated with an increased risk of death from CVD and all causes. Findings provide support for the importance of compliance with therapy in RA patients who are prescribed statins.
authors.affiliation: Arthritis Research Centre of Canada, Vancouver, British Columbia, Canada. mdevera@arthritisresearch.ca.
authors.forename: Mary A
authors.initials: MA
authors.lastname: De Vera
authors.forename: Hyon
authors.initials: H
authors.lastname: Choi
authors.forename: Michal
authors.initials: M
authors.lastname: Abrahamowicz
authors.forename: Jacek
authors.initials: J
authors.lastname: Kopec
authors.forename: Diane
authors.initials: D
authors.lastname: Lacaille
mesh_terms: D000368:Aged; D001172:Arthritis, Rheumatoid / Q000453:epidemiology / Q000401:mortality*; D002318:Cardiovascular Diseases / Q000188:drug therapy* / Q000453:epidemiology / Q000401:mortality*; D015331:Cohort Studies; D015897:Comorbidity; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use*; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012307:Risk Factors; D028761:Withholding Treatment
chemical_list: D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors