Using data from 37,151 RA patients who received health services in British Columbia from 1996 to 2006, De Vera and her team identified 4,102 who were prescribed statin drugs. Data came from the British Columbia Ministry of Health records.

Among this group of RA patients taking statins:

  • 45 percent discontinued therapy at least once during the four-year follow-up period.
  • There were 467 deaths overall, with 198 deaths from heart disease.
  • Of the heart disease-related deaths, 31 percent were from heart attacks and 15 percent from strokes.

De Vera’s team reports that stopping statin therapy resulted in:

  • 60 percent higher risk of heart disease-related death, and
  • 79 percent higher risk of death from all causes.

De Vera defined “discontinued” as quitting for three months or longer. “Stopping for one or two months was not considered stopping,” she says. “Sometimes people have trouble getting to the pharmacy on time to refill. We wanted to give them the benefit of the doubt.”

How long the patients had been taking statins before they quit – or if they were intermittent, quitting for several months, then going back on the drugs – didn’t matter, she explains. “Anyone who discontinued the statin medication increased their death risk during the four-year follow-up period.”

While De Vera did not have access to data on patients’ cholesterol levels, she says, “People generally are prescribed statins because they have elevated lipids [cholesterol] as well as signs of cardiovascular disease.”

Jeffrey Curtis, MD, director of the Arthritis Clinical Intervention Program at the University of Alabama at Birmingham (UAB), is not surprised by the findings. “This study confirms what medical specialists have known – that statins work among people who take them,” he says. “But should all RA patients take statins? That’s not yet clear. Right now, we prescribe statins according to the general guidelines – if LDL cholesterol is 160 or greater, and at lower thresholds, depending on what other cardiovascular risk factors the patient has.”

Whether RA should be considered one of those risk factors has not yet been determined, he adds. “We don’t have complete knowledge to accurately estimate cardiovascular risk for RA patients.”

Another fact that RA patients should understand is that their risk of heart disease develops about five to 10 years earlier than in the general population, Dr. Curtis adds. 

“As a practical matter, it’s helpful if patients are aware of their cholesterol, blood pressure and cardiovascular risk factors, and act as their own advocate, making sure those risks are managed,” he says. “There are many effective medications to treat those conditions, and they are traditionally managed by the primary care physician. It’s usually best for patients to see a primary care doctor in addition to a rheumatologist.”