Reduction of Cardiovascular Disease and Mortality Versus Risk of New‐Onset Diabetes Mellitus With Statin Use in Patients With Rheumatoid Arthritis

Objective To assess the effect of statin use on the risk of cardiovascular disease (CVD), all‐cause mortality, and type 2 diabetes mellitus (DM) in patients with rheumatoid arthritis (RA). Methods We identified a cohort of patients with RA between 1989 and 2018, within the UK Clinical Practice Research Datalink. We employed a prevalent new‐user cohort design by which patients initiating statins were each matched to 2 concurrent nonusers by the time‐conditional propensity score (TCPS). Patients were followed until the occurrence of the composite end point of myocardial infarction, stroke, hospitalized heart failure or CVD mortality, all‐cause mortality, and incident type 2 DM. The Cox proportional hazards model was used to estimate the hazard ratio (HR) of each outcome associated with as‐treated statin use, with adjustment for TCPS deciles and imbalanced covariables. Results Among 1,768 statin initiators and 3,528 nonusers, 63 versus 340 CVD (3.0 per 100 person‐years versus 2.7 per 100 person‐years) and 62 versus 525 deaths (2.8 per 100 person‐years versus 4.1 per 100 person‐years) occurred. Incident type 2 DM was noted in 128 of 3,608 statin initiators (3.0 per 100 person‐years) and 518 of 7,208 nonusers (2.0 per 100 person‐years). Statin initiation was associated with 32% (HR 0.68 [95% confidence interval (95% CI) 0.51–0.90]) reduction in CVD, 54% (HR 0.46 [95% CI 0.35–0.60]) reduction in all‐cause mortality, and 33% increase in type 2 DM (HR 1.33 [95% CI 1.09–1.63]). The number needed to treat/number needed to harm to prevent a CVD or all‐cause mortality or to cause type 2 DM in 1 year was 102, 42, and 127, respectively. Conclusion Statins are associated with important reductions in CVD and mortality that outweigh the modest increase in type 2 DM risk in RA patients.