Monday, 21 Aug 2017

You are here

Statins Improve Survival in Ankylosing Spondylitis

Systemic inflammation (from underling inflammatory polyarthritis) clearly accelerates atherosclerosis with a resultant increase risk of cardiovascular disease.

A recent population-based cohort study published by Dr. Exarchou et al showed that patients with ankylosing spondylitis (AS) are at 60% increased risk of premature mortality with CV events being more common in AS than in the general population (1). At the same time there is little known about how CV risk factor modification modalities may affect this outcome. In multiple RA studies it has been shown that statin initiation can decrease CV mortality risk by up to 20%.

In a recent study, conducted by a researchers from UK , the goal was to investigate similar relationships between statin initiation and the risk of all-cause mortality in patients with AS in a general population context.

This population-based cohort study compared adult AS patients who carried a diagnosis of AS for at least a year between 2000 and 2014 to the general population. 

1430 AS patients who started a statin were randomly matched 1:1 and compared to statin non-initiators. It was observed that patients in the statin group had higher prevalence of CV disease, more CV risk factors and higher use of CV medications (confounding by indication).

After initial characteristic groups were balanced in statistical analysis, mortality rates in statin initiation and statin non-initiation groups were 16.5 and 23.8 per 1000 PYs, respectively, and the HR for mortality associated with statin initiation was 0.63 (95% CI 0.46 to 0.85). The corresponding absolute mortality rate difference was 7.3 deaths per 1000 PYs (95% CI 2.1 to 12.5).

Statin initiation was associated with a 37% reduction in all-cause mortality. This association was independent of age, sex, BMI socioeconomic status, relevant comorbidities, cardiovascular medication use, total cholesterol levels and healthcare utilization.

Interestingly, the magnitude of this association was much higher in AS as compared to similar RA studies. Further studies would be required to define the role of statin use in AS care, which could potentially lead to incorporation of statin therapy into guidelines for the management of cardiovascular risk in AS.

Disclosures: 
The author has no conflicts of interest to disclose related to this subject

Add new comment

More Like This

Psoriatic Arthritis Patients with Comorbidities have Worse Disease and Poor Responses

A population-based cohort study shows that comorbidities in psoriatic arthritis patients (PsA) were associated with higher disease activity, shorter persistence and reduced clinical response to TNF inhibitors (TNFi). 

FDA Arthritis Advisory Panel Endorses Tofacitinib Approval for Psoriatic Arthritis

On Thursday, August 3, the FDA Arthritis Advisory Committee (AAC) met to consider tofacitinib for use in patients with psoriatic arthritis. The panel voted 10-1 in favor of approval.

Pediatric Consensus on Comorbidity Assessments

Comorbidity is a serious consequence or confounder in patients with inflammatory diseases. This has been well described in both psoriatic and rheumatoid disease.  JAMA Dermatology has published the recommendations of a pediatric multispecialty group regarding the screening for comorbid disease. (Citation source https://buff.ly/2u4pi3J)

Obesity Impairs TNF Inhibitor Responses in Axial Spondyloarthritis

Investigators with the Swiss Clinical Quality Management (SCQM) program have studied the effects of obesity on patients with axial spondyloarthritis (axSpA) and, specifically, their response to tumor necrosis factor inhibitors (TNFi).

FDA Approves Tremfya (guselkumab) for Plaque Psoriasis

The U.S. Food and Drug Administration (FDA) has approved the IL-23 inhibitor, Tremfya (guselkumab), for patients with moderate to severe plaque psoriasis.