Impact of Statin Discontinuation on Mortality in Patients With Rheumatoid Arthritis: A Population-Based Study

Objective. To evaluate the impact of statin discontinuation on cardiovascular disease (CVD) mortality and all-cause mortality in a population-based cohort of patients with rheumatoid arthritis (RA). Methods. We conducted a population-based longitudinal study of RA patients with incident statin use followed from 1996 to 2006 using administrative health data. Statin discontinuation was defined as persistent nonuse for >= 3 months during the therapy course. Primary outcomes were mortality from all CVDs (CVD mortality) and secondary outcomes were deaths from all causes (all-cause mortality). Cox proportional hazards models with statin discontinuation as a time-dependent variable were used and multivariable models were adjusted for age, sex, comorbidities, and risk factors for mortality, and proxy indicators of RA severity. Results. Over 16,144 person-years of followup in the cohort of 4,102 incident statin users, we documented 198 deaths due to CVD and 467 deaths overall. Adjusted hazard ratios for the association of statin discontinuation with death were 1.60 (95% confidence interval [95% CI] 1.15-2.23) for CVD mortality and 1.79 (95% CI 1.46-2.20) for all-cause mortality. The association between statin discontinuation and mortality outcomes was not modified by timing of the first statin prescription, age, and sex (P values for interaction >= 0.29). Conclusion. These population-based data indicate that statin discontinuation in patients with RA is associated with an increased risk of death from CVD and all causes. Findings provide support for the importance of compliance with therapy in RA patients who are prescribed statins.