Statins tied to lower mortality risk in ankylosing spondylitis

By Anne Harding

NEW YORK (Reuters Health) - Patients with ankylosing spondylitis (AS) who start taking statins live longer than those who aren’t on the cholesterol-lowering drugs, according to a new population-based cohort study.

“The study suggests that statins could be potentially a good cardiovascular protective or management option for AS patients,” Dr. Hyon K. Choi of Massachusetts General Hospital in Boston told Reuters Health in a telephone interview.

People with AS are at increased risk of cardiovascular disease and mortality. Studies suggest that statins may have antinflammatory as well as cholesterol-lowering benefits, including in patients with rheumatoid arthritis, Dr. Choi and his team note in Annals of the Rheumatic Diseases, online July 11.

The researchers used data from The Health Improvement Network, a U.K. database including about 11 million patients, to compare mortality in statin initiators and statin non-initiators with AS in 2000-2014. Using propensity score matching, they compared 1,108 patients with AS who started taking statins and 1,108 who did not.

During follow-up, which lasted about five years, 96 of the statin initiators died, versus 134 of those who did not start taking statins, translating to a mortality rate of 16.5 and 23.8 per 1,000 person-years, respectively, a significant difference. The hazard ratio for mortality was 0.63 in statin initiators.

Based on the findings, Dr. Choi said, clinicians should have a low threshold for prescribing statins in AS patients who are at risk for cardiovascular disease.

He and his colleagues are planning to investigate which causes of death may be most beneficially affected by statin use in AS patients, as well as the effects of other medications, such as non-steroidal anti-inflammatory drugs, on mortality risk.

Dr. Nigil Haroon, a rheumatologist at the University of Toronto who studies AS, said the study is important, noting that the researchers were able to control for cholesterol levels.

“How much we can extrapolate this to a regular routine clinical presentation of a patient, I’m not 100% sure,” he told Reuters Health by telephone.

While the average age of the AS patients in the study was about 62, Dr. Haroon noted, patients today may be diagnosed in their 30s or 40s. “I don’t think we have enough information to start statins straight away with those patients,” he said.

But prescribing statins is probably warranted in patients with AS who do have cardiovascular risk factors or a history of cardiovascular disease - who may already be on the drug anyway, he said.

Both Dr. Haroon and Dr. Choi note that powerful anti-inflammatory drugs used to treat AS today may be able to help reduce cardiovascular disease risk and mortality.

The authors declared no competing interests and reported no study funding.

SOURCE: https://bit.ly/2viOiVV

Ann Rheum Dis 2017.

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