Ankylosing spondylitis: statins reduce all-cause mortality by 37%

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Takeaway
  • In patients with ankylosing spondylitis (AS), statin initiation was associated with a 37% reduction in all-cause mortality, independent of age, sex, BMI, socioeconomic status, relevant comorbidities, cardiovascular medication use, total cholesterol levels, and healthcare utilisation. 

Why this matters

  • Similar to patients with rheumatoid arthritis (RA), patients with AS are at an increased risk for cardiovascular disease (CVD) and mortality. 
  • Statins have been associated with 20% reduced mortality in RA patients, most likely due to their dual cholesterol-lowering and systemic anti-inflammatory effects. 
  • This is the first study to find a potentially substantial mortality benefit of statin use in patients with AS.

Key results

  • Among patients with AS who were initiated on a statin, there were 96 deaths over a mean follow-up of 5.3 y compared with 134 deaths in the non-initiator group over a mean follow-up period of 5.1 y. 
  • Using propensity score matching, the corresponding mortality rates were 16.5 and 23.8 per 1000 patient years (PYs), respectively. 
  • The absolute mortality rate difference was 7.3 (95% CI, 2.1-12.5) deaths per 1000 PYs. 
  • HR for mortality associated with statin initiation was 0.63 (95% CI, 0.46-0.85).

Study design

  • Cohort study of 1108 patients with AS who initiated a statin and 1108 non-initiators, using data from a UK general population database. 
  • Funding: None specified.

Limitations

  • Observational design. 
  • Incomplete information on disease severity and use of AS therapies.