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Statin reduces mortality and morbidity in systemic lupus erythematosus patients with hyperlipidemia: A nationwide population-based cohort study.

Abstract

OBJECTIVE

The anti-inflammatory and cardiovascular protective effects of statin for patients with systemic lupus erythematosus (SLE) are not clear. We tested the hypothesis that statin use is associated with reduced mortality and morbidity in SLE patients with hyperlipidemia.

METHODS

We included 4095 patients with SLE and hyperlipidemia from the entire population using the Taiwan National Health Insurance Research Database between 1997 and 2008. A total of 935 matching sets (1:2) of patients who had never used lipid-lowering medications and statin users were included in the nested matched cohort. Cox proportional hazards regression was used to calculate the hazard ratios (HR) and 95% confidence intervals (CI) for the association between statin and all-cause mortality, coronary artery disease (CAD), cerebrovascular disease (CVD) and end-stage renal disease (ESRD), conditional for matching sets in the matched cohort.

RESULTS

The multivariate adjusted hazard ratios (HR) for statin users, as compared with patients had never used lipid-lowering medications, were 0.67 (95% CI, 0.54 to 0.83) for death from any cause. High-dose statins (>365 cumulative defined daily dose) significantly reduced risk of all-cause mortality (HR 0.44, 95% CI 0.32 to 0.60); CAD (HR 0.20, 95% CI 0.13 to 0.31); CVD (HR 0.14, 95% CI 0.08 to 0.25); and ESRD (HR 0.22, 95% CI, 0.16 to 0.29), with similar results in the nested matched study.

CONCLUSION

Statin therapy in SLE patients with hyperlipidemia may reduce the risk of mortality, cardiovascular disease and ESRD. The effect of statins needs to be demonstrated in large prospective studies with long-term follow-up.

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  • Authors+Show Affiliations

    ,

    Department of Pediatrics, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan.

    ,

    Institute of Occupational Medicine and Industrial Hygiene, National Taiwan University College of Public Health, Taipei, Taiwan.

    ,

    Department of Pediatrics, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan.

    ,

    Department of Pediatrics, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan.

    ,

    Department of Pediatrics, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan.

    ,

    Department of Pediatrics, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan.

    Department of Medical Research, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan. Electronic address: gicmbor@ntu.edu.tw.

    Source

    Atherosclerosis 243:1 2015 Nov pg 11-8

    MeSH

    Adult
    Anti-Inflammatory Agents
    Cerebrovascular Disorders
    Cohort Studies
    Coronary Artery Disease
    Dose-Response Relationship, Drug
    Female
    Humans
    Hydroxymethylglutaryl-CoA Reductase Inhibitors
    Hyperlipidemias
    Immunologic Factors
    Kidney Failure, Chronic
    Lupus Erythematosus, Systemic
    Male
    Middle Aged
    Multivariate Analysis
    Proportional Hazards Models
    Registries
    Regression Analysis
    Reproducibility of Results
    Taiwan

    Pub Type(s)

    Journal Article
    Research Support, Non-U.S. Gov't

    Language

    eng

    PubMed ID

    26342937

    Citation

    Yu, Hsin-Hui, et al. "Statin Reduces Mortality and Morbidity in Systemic Lupus Erythematosus Patients With Hyperlipidemia: a Nationwide Population-based Cohort Study." Atherosclerosis, vol. 243, no. 1, 2015, pp. 11-8.
    Yu HH, Chen PC, Yang YH, et al. Statin reduces mortality and morbidity in systemic lupus erythematosus patients with hyperlipidemia: A nationwide population-based cohort study. Atherosclerosis. 2015;243(1):11-8.
    Yu, H. H., Chen, P. C., Yang, Y. H., Wang, L. C., Lee, J. H., Lin, Y. T., & Chiang, B. L. (2015). Statin reduces mortality and morbidity in systemic lupus erythematosus patients with hyperlipidemia: A nationwide population-based cohort study. Atherosclerosis, 243(1), pp. 11-8. doi:10.1016/j.atherosclerosis.2015.08.030.
    Yu HH, et al. Statin Reduces Mortality and Morbidity in Systemic Lupus Erythematosus Patients With Hyperlipidemia: a Nationwide Population-based Cohort Study. Atherosclerosis. 2015;243(1):11-8. PubMed PMID: 26342937.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - Statin reduces mortality and morbidity in systemic lupus erythematosus patients with hyperlipidemia: A nationwide population-based cohort study. AU - Yu,Hsin-Hui, AU - Chen,Pau-Chung, AU - Yang,Yao-Hsu, AU - Wang,Li-Chieh, AU - Lee,Jyh-Hong, AU - Lin,Yu-Tsan, AU - Chiang,Bor-Luen, Y1 - 2015/08/28/ PY - 2015/05/21/received PY - 2015/08/10/revised PY - 2015/08/22/accepted PY - 2015/9/7/entrez PY - 2015/9/8/pubmed PY - 2016/9/15/medline KW - Cardiovascular disease KW - Epidemiology KW - Mortality KW - Statin KW - Systemic lupus erythematosus SP - 11 EP - 8 JF - Atherosclerosis JO - Atherosclerosis VL - 243 IS - 1 N2 - OBJECTIVE: The anti-inflammatory and cardiovascular protective effects of statin for patients with systemic lupus erythematosus (SLE) are not clear. We tested the hypothesis that statin use is associated with reduced mortality and morbidity in SLE patients with hyperlipidemia. METHODS: We included 4095 patients with SLE and hyperlipidemia from the entire population using the Taiwan National Health Insurance Research Database between 1997 and 2008. A total of 935 matching sets (1:2) of patients who had never used lipid-lowering medications and statin users were included in the nested matched cohort. Cox proportional hazards regression was used to calculate the hazard ratios (HR) and 95% confidence intervals (CI) for the association between statin and all-cause mortality, coronary artery disease (CAD), cerebrovascular disease (CVD) and end-stage renal disease (ESRD), conditional for matching sets in the matched cohort. RESULTS: The multivariate adjusted hazard ratios (HR) for statin users, as compared with patients had never used lipid-lowering medications, were 0.67 (95% CI, 0.54 to 0.83) for death from any cause. High-dose statins (>365 cumulative defined daily dose) significantly reduced risk of all-cause mortality (HR 0.44, 95% CI 0.32 to 0.60); CAD (HR 0.20, 95% CI 0.13 to 0.31); CVD (HR 0.14, 95% CI 0.08 to 0.25); and ESRD (HR 0.22, 95% CI, 0.16 to 0.29), with similar results in the nested matched study. CONCLUSION: Statin therapy in SLE patients with hyperlipidemia may reduce the risk of mortality, cardiovascular disease and ESRD. The effect of statins needs to be demonstrated in large prospective studies with long-term follow-up. SN - 1879-1484 UR - https://www.unboundmedicine.com/medline/citation/26342937/Statin_reduces_mortality_and_morbidity_in_systemic_lupus_erythematosus_patients_with_hyperlipidemia:_A_nationwide_population_based_cohort_study_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0021-9150(15)30093-9 DB - PRIME DP - Unbound Medicine ER -