Effect of statin therapy on the prevention of new-onset acute coronary syndrome in patients with rheumatoid arthritis

Chen Yu Huang, Ting Tse Lin, Yao Hsu Yang, Lian Yu Lin, Chia Ti Tsai, Juey Jen Hwang, Pau Chung Chen, Jiunn Lee Lin

Research output: Contribution to journalArticle

4 Citations (Scopus)

Abstract

Background The aim of this study is to investigate whether statin therapy can reduce new-onset acute coronary syndrome (ACS) in patients with rheumatoid arthritis (RA). Methods We used a database from the Registry for Catastrophic Illness from the National Health Research Institute (NHRI) in Taiwan. All RA patients aged 18 or older, diagnosed between 1995 and 2013, without previous cardiovascular events were included. We divided participants into quartiles according to the accumulated statin equivalent dosage and tertiles of period of days of statin treatment to examine the possible dose–response effect. To avoid confounding effects, a 1:4 propensity score matching and Cox's proportional hazard regression models were applied to estimate the hazard ratios for ACS events in patients with and without statin use. Results Total 49,227 patients were included and PS matching identified 5483 patients receiving statins and 21,932 who did not. RA patients treated with statins had lower incidence of first ACS event (IRR 0.779, 95% CI: 0.654–0.927, p = 0.005) after PS matching. Statin therapy is associated with reduced risk of new ACS before PS matching (HR = 0.847, 95% CI: 0.737–0.973, p = 0.019) and the beneficial effect is correlated with accumulated dose and therapy duration (HRs from Q1 to Q4 are 1.215, 0.825, 0.716 and 0.611, p < 0.001 for trend; HRs from T1 to T3 are 1.100, 0.841 and 0.611, p < 0.001 for trend). These results remained robust after propensity matching. Comparison between 6 different statins, rosuvastatin seems to be associated with better outcome on ACS primary prevention after excluding participants taking more than one kind of statin. Conclusions Our study demonstrated that statin therapy is associated with lower event rate of new-onset ACS in RA patients and the beneficial effect is dose-responsive.

Original languageEnglish
Pages (from-to)1-6
Number of pages6
JournalInternational Journal of Cardiology
Volume253
DOIs
Publication statusPublished - Feb 15 2018
Externally publishedYes

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Hydroxymethylglutaryl-CoA Reductase Inhibitors
Acute Coronary Syndrome
Rheumatoid Arthritis
Therapeutics
Catastrophic Illness
Propensity Score
Primary Prevention
Taiwan
Proportional Hazards Models
Registries
Databases

Keywords

  • Acute coronary syndrome
  • Propensity score
  • Rheumatoid arthritis
  • Statins

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Effect of statin therapy on the prevention of new-onset acute coronary syndrome in patients with rheumatoid arthritis. / Huang, Chen Yu; Lin, Ting Tse; Yang, Yao Hsu; Lin, Lian Yu; Tsai, Chia Ti; Hwang, Juey Jen; Chen, Pau Chung; Lin, Jiunn Lee.

In: International Journal of Cardiology, Vol. 253, 15.02.2018, p. 1-6.

Research output: Contribution to journalArticle

Huang, Chen Yu ; Lin, Ting Tse ; Yang, Yao Hsu ; Lin, Lian Yu ; Tsai, Chia Ti ; Hwang, Juey Jen ; Chen, Pau Chung ; Lin, Jiunn Lee. / Effect of statin therapy on the prevention of new-onset acute coronary syndrome in patients with rheumatoid arthritis. In: International Journal of Cardiology. 2018 ; Vol. 253. pp. 1-6.
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abstract = "Background The aim of this study is to investigate whether statin therapy can reduce new-onset acute coronary syndrome (ACS) in patients with rheumatoid arthritis (RA). Methods We used a database from the Registry for Catastrophic Illness from the National Health Research Institute (NHRI) in Taiwan. All RA patients aged 18 or older, diagnosed between 1995 and 2013, without previous cardiovascular events were included. We divided participants into quartiles according to the accumulated statin equivalent dosage and tertiles of period of days of statin treatment to examine the possible dose–response effect. To avoid confounding effects, a 1:4 propensity score matching and Cox's proportional hazard regression models were applied to estimate the hazard ratios for ACS events in patients with and without statin use. Results Total 49,227 patients were included and PS matching identified 5483 patients receiving statins and 21,932 who did not. RA patients treated with statins had lower incidence of first ACS event (IRR 0.779, 95{\%} CI: 0.654–0.927, p = 0.005) after PS matching. Statin therapy is associated with reduced risk of new ACS before PS matching (HR = 0.847, 95{\%} CI: 0.737–0.973, p = 0.019) and the beneficial effect is correlated with accumulated dose and therapy duration (HRs from Q1 to Q4 are 1.215, 0.825, 0.716 and 0.611, p < 0.001 for trend; HRs from T1 to T3 are 1.100, 0.841 and 0.611, p < 0.001 for trend). These results remained robust after propensity matching. Comparison between 6 different statins, rosuvastatin seems to be associated with better outcome on ACS primary prevention after excluding participants taking more than one kind of statin. Conclusions Our study demonstrated that statin therapy is associated with lower event rate of new-onset ACS in RA patients and the beneficial effect is dose-responsive.",
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AU - Huang, Chen Yu

AU - Lin, Ting Tse

AU - Yang, Yao Hsu

AU - Lin, Lian Yu

AU - Tsai, Chia Ti

AU - Hwang, Juey Jen

AU - Chen, Pau Chung

AU - Lin, Jiunn Lee

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N2 - Background The aim of this study is to investigate whether statin therapy can reduce new-onset acute coronary syndrome (ACS) in patients with rheumatoid arthritis (RA). Methods We used a database from the Registry for Catastrophic Illness from the National Health Research Institute (NHRI) in Taiwan. All RA patients aged 18 or older, diagnosed between 1995 and 2013, without previous cardiovascular events were included. We divided participants into quartiles according to the accumulated statin equivalent dosage and tertiles of period of days of statin treatment to examine the possible dose–response effect. To avoid confounding effects, a 1:4 propensity score matching and Cox's proportional hazard regression models were applied to estimate the hazard ratios for ACS events in patients with and without statin use. Results Total 49,227 patients were included and PS matching identified 5483 patients receiving statins and 21,932 who did not. RA patients treated with statins had lower incidence of first ACS event (IRR 0.779, 95% CI: 0.654–0.927, p = 0.005) after PS matching. Statin therapy is associated with reduced risk of new ACS before PS matching (HR = 0.847, 95% CI: 0.737–0.973, p = 0.019) and the beneficial effect is correlated with accumulated dose and therapy duration (HRs from Q1 to Q4 are 1.215, 0.825, 0.716 and 0.611, p < 0.001 for trend; HRs from T1 to T3 are 1.100, 0.841 and 0.611, p < 0.001 for trend). These results remained robust after propensity matching. Comparison between 6 different statins, rosuvastatin seems to be associated with better outcome on ACS primary prevention after excluding participants taking more than one kind of statin. Conclusions Our study demonstrated that statin therapy is associated with lower event rate of new-onset ACS in RA patients and the beneficial effect is dose-responsive.

AB - Background The aim of this study is to investigate whether statin therapy can reduce new-onset acute coronary syndrome (ACS) in patients with rheumatoid arthritis (RA). Methods We used a database from the Registry for Catastrophic Illness from the National Health Research Institute (NHRI) in Taiwan. All RA patients aged 18 or older, diagnosed between 1995 and 2013, without previous cardiovascular events were included. We divided participants into quartiles according to the accumulated statin equivalent dosage and tertiles of period of days of statin treatment to examine the possible dose–response effect. To avoid confounding effects, a 1:4 propensity score matching and Cox's proportional hazard regression models were applied to estimate the hazard ratios for ACS events in patients with and without statin use. Results Total 49,227 patients were included and PS matching identified 5483 patients receiving statins and 21,932 who did not. RA patients treated with statins had lower incidence of first ACS event (IRR 0.779, 95% CI: 0.654–0.927, p = 0.005) after PS matching. Statin therapy is associated with reduced risk of new ACS before PS matching (HR = 0.847, 95% CI: 0.737–0.973, p = 0.019) and the beneficial effect is correlated with accumulated dose and therapy duration (HRs from Q1 to Q4 are 1.215, 0.825, 0.716 and 0.611, p < 0.001 for trend; HRs from T1 to T3 are 1.100, 0.841 and 0.611, p < 0.001 for trend). These results remained robust after propensity matching. Comparison between 6 different statins, rosuvastatin seems to be associated with better outcome on ACS primary prevention after excluding participants taking more than one kind of statin. Conclusions Our study demonstrated that statin therapy is associated with lower event rate of new-onset ACS in RA patients and the beneficial effect is dose-responsive.

KW - Acute coronary syndrome

KW - Propensity score

KW - Rheumatoid arthritis

KW - Statins

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