title: Statin use and mortality in rheumatoid arthritis: a general population-based cohort study.
abstract: Dual lipid-lowering and anti-inflammatory properties of statins may lead to survival benefits in patients with rheumatoid arthritis (RA). However, data on this topic are limited, and the role of statins in RA remains unclear.
  
  
  
  To examine the association of statin use with overall mortality among patients with RA in a general population context.
  
  
  
  We conducted an incident user cohort study with time-stratified propensity score matching using a UK general population database. The study population included individuals aged ≥20 years who had a diagnosis of RA and had used at least one disease-modifying antirheumatic drug (DMARD) between January 2000 and December 2012. To closely account for potential confounders, we compared propensity score matched cohorts of statin initiators and comparators (non-initiators) within 1-year cohort accrual blocks.
  
  
  
  432 deaths occurred during follow-up (mean 4.51 years) of the 2943 statin initiators for an incidence rate of 32.6/1000 person-years (PY), while the 513 deaths among 2943 matched comparators resulted in an incidence rate of 40.6/1000 PY. Baseline characteristics were well-balanced across the two groups. Statin initiation was associated with a 21% lower risk of all-cause mortality (HR=0.79, 95% CI 0.68 to 0.91). When we defined RA by its diagnosis code alone (not requiring DMARD use), the corresponding HR was 0.81 (95% CI 0.74 to 0.90).
  
  
  
  Statin initiation is associated with a lower risk of mortality among patients with RA. The magnitude of association is similar to that seen in previous randomised trials among the general population.
authors.affiliation: Division of Rheumatology, Allergy and Immunology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA.
authors.forename: Sara R
authors.initials: SR
authors.lastname: Schoenfeld
authors.affiliation: Division of Rheumatology, Allergy and Immunology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA Clinical Epidemiology Unit, Boston University School of Medicine, Boston, Massachusetts, USA.
authors.forename: Leo
authors.initials: L
authors.lastname: Lu
authors.affiliation: Arthritis Research Centre of Canada, University of British Columbia, Vancouver, British Columbia, Canada.
authors.forename: Sharan K
authors.initials: SK
authors.lastname: Rai
authors.affiliation: Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusettes, USA.
authors.forename: John D
authors.initials: JD
authors.lastname: Seeger
authors.affiliation: Clinical Epidemiology Unit, Boston University School of Medicine, Boston, Massachusetts, USA.
authors.forename: Yuqing
authors.initials: Y
authors.lastname: Zhang
authors.affiliation: Division of Rheumatology, Allergy and Immunology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA Clinical Epidemiology Unit, Boston University School of Medicine, Boston, Massachusetts, USA.
authors.forename: Hyon K
authors.initials: HK
authors.lastname: Choi
mesh_terms: D000368:Aged; D018501:Antirheumatic Agents / Q000627:therapeutic use*; D001172:Arthritis, Rheumatoid / Q000188:drug therapy / Q000401:mortality*; D002423:Cause of Death; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D057216:Propensity Score
chemical_list: D018501:Antirheumatic Agents; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors
keywords: Outcomes research; Rheumatoid Arthritis; Treatment