The effect of statin on major adverse cardiovascular events and mortality in patients with rheumatoid arthritis – a systematic review and meta-analysis

A.R. Rahmadi, R. Pranata, W.M. Raffaello, E. Yonas, M.P. Ramadhian, M.R.R. Natadikarta, M.R. Akbar

Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, Universitas Padjadjaran, Hasan Sadikin General Hospital, Bandung, Indonesia. m.r.akbar@unpad.ac.id

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• Cardiology
• Rheumatology

OBJECTIVE: The aim of this systematic review and meta-analysis is to assess the effect of statin on major adverse cardiovascular events (MACE) and mortality in patients with RA.

MATERIALS AND METHODS: A systematic literature search was performed using PubMed, Scopus, Embase, and Clinicaltrials.gov for studies investigating the effect of statin on MACE and mortality in RA patients up until 6 February 2022. The primary outcome was MACE, which can be defined as nonfatal myocardial infarction (MI), nonfatal presumed ischemic stroke, transient ischemic attack, any coronary or non-coronary revascularization, or cardiovascular death. The pooled effect estimated was reported as hazard ratio (HR).

RESULTS: There were 40,307 patients from a total of six studies, comprising of one double-blind placebo controlled randomized controlled trial, four propensity-score matched cohorts, and one observational study included in this meta-analysis. The rate of MACE was lower in RA patients receiving statin [OR 0.67 (95%CI 0.51, 0.89), p=0.005; I2: 21.0%, p=0.29] (Figure 2). Sensitivity analysis using fixed-effect model showed that MACE was lower in the statin group [OR 0.73 (95%CI 0.62, 0.87), p<0.0051 I2: 21.0%, p=0.29]. Mortality was lower in RA patients receiving statin [OR 0.73 (95%CI 0.62, 0.88), p<0.001; I2: 29.0%, p=0.25] (Figure 3). Sensitivity analysis using fixed-effect model showed that mortality was lower in the statin group [OR 0.75 (95%CI 0.66, 0.85), p<0.001 I2: 29.0%, p=0.25].

CONCLUSIONS: This systematic review and meta-analysis showed that statin was associated with reduction of MACE and mortality in patients with RA.

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