The comparative effectiveness of statin therapy in selected chronic diseases compared with the remaining population

Abstract

BackgroundTotal cholesterol (TC) concentration is the most commonly used measure of statin efficacy in the UK. This study aimed to evaluate the effectiveness of statins in lowering TC, cardiovascular events (CV) and mortality five common chronic diseases (chronic obstructive pulmonary disease (COPD), osteoarthritis (OA), rheumatoid arthritis (RA), chronic kidney disease (CKD), and diabetes mellitus (DM)) and to compare effectiveness with the rest of the population not recorded as having these diseases.MethodsA population-based cohort study was conducted in Tayside population who had at least two TC measurements between 1993 and 2007. There were 12,140 patients with chronic diseases and 9,481 patients in the rest of the population not recorded as having these chronic diseases. The main outcomes were TC change from baseline, CV events and all-cause mortality.ResultsStatin-associated TC reductions varied from 15% to 28% with baseline value of between 5.1 and 5.9 mmol/L in the primary prevention (PP) and from 7% to 23% with baseline value of 4.5 to 5.2 mmol/L in the secondary prevention (SP) among chronic diseases patients. In the rest of the population, TC reductions with statins were 31% in PP and 28% in SP with baselines of 6.3 mmol/L and 5.3 mmol/L, respectively (test of heterogeneity with chronic disease groups: p < 0.001). A notional reduction of 0.5 mmol/L in TC predicted variable reductions in incident CV events of 30% in RA, 19% in CKD, and 20% in DM, and recurrent CV events by 62% in COPD, 16% in CKD, and 19% in DM. The corresponding figures for the rest of population were 12% for incident CV events and 17% for the recurrent CV events, respectively. Risk reductions for all-cause mortality varied from 20% to 36% in PP and from 18% to 40% in SP, except in OA or RA patients in the chronic diseases and 11% in PP and 16% in the rest of population (test of heterogeneity: p > 0.05).ConclusionsThe effectiveness of statins in common chronic diseases varied. With the exception of diabetes, statins tends to be less effective in patients with the chronic diseases compared with the rest of the study population. Changes in TC with statins appear not to correlate well with the changes in cardiovascular events and all-cause mortality.

Targeting the mevalonate cascade as a new therapeutic approach in heart disease, cancer and pulmonary disease

“…In COPD, statins also protect against cardiovascular events and mortality when done as secondary prevention of known cardiovascular disease (Sheng, Murphy, MacDonald, Schembri, et al, 2012). Statin consumption is also associated with reductions in all-cause mortality in COPD in both primary and secondary prevention of cardiovascular disease (Sheng, Murphy, MacDonald, & Wei, 2012). …”

Management of cardiovascular risk in patients with rheumatoid arthritis: evidence and expert opinion

“…Based on data from epidemiological studies and post hoc subgroup analyses of large, secondary CV prevention trials, the effects of statins on cholesterol levels in RA patients appear to be at least equivalent to the effects of statins in the general population [Rollefstad et al 2012; Semb et al 2011, 2012]. In contrast, one recently published population-based longitudinal study found that the effectiveness of statins varied in chronic diseases, including RA, and tended to be less effective than in the rest of the population [Sheng et al 2012b]. There are, however, numerous other studies that show beneficial effects of statins and angiotensin-converting enzyme (ACE) inhibitors on CV risk in RA [Charles-Schoeman et al 2007; Flammer et al 2008; Hermann et al 2005; Maki-Petaja et al 2007; Sheng et al 2012a; Van Doornum et al 2004].…”

The Role of Statins in Disease Modification and Cardiovascular Risk in Rheumatoid Arthritis

“…Lipid profile alterations, displaying an inverse correlation between total cholesterol (TC) levels and disease activity, raise some questions about the exact value of lipid lowering treatment in RA ( 25 ). High level inflammation on the one hand and potent antiinflammatory disease-modifying antirheumatic drugs (DMARDs) on the other have significant contrasting effects on lipid levels and could modify the lipid lowering effectiveness and consequent CVD risk reduction impact of statins in RA ( 26 , 27 ).…”