Effect of statin use on cardiovascular events and all-cause mortality in immune-mediated inflammatory diseases: A systematic review and meta-analysis involving 148,722 participants

Abstract Background Immune-mediated inflammatory diseases (IMIDs) are associated with an increased risk of premature cardiovascular disease and all-cause mortality. Given lipid-lowering and anti-inflammatory properties, statins theoretically provide greater survival benefits for patients with IMIDs. Objective We aimed to evaluate the impact of statin on all-cause mortality and cardiovascular risk in patients with IMIDs, and examine whether the effect varies between primary prevention and secondary prevention. Methods We systematically searched PubMed, EMBASE and Cochrane Library to identify eligible studies evaluating the association between statin use and all-cause mortality or cardiovascular events in IMIDs. Data were pooled using fixed-effects or random-effects meta-analysis according to I2 and pooled hazard ratios (HRs) and 95 % confidence intervals (CIs) were used as summary statistic. Results Our meta-analysis included 12 studies that comprised 148,722 patients with IMIDs (57,670 statin users, 91,052 statin non-users) contributing more than 840,113 patient-years. In pooled analysis, statin initiation was associated with 28 % decreased risk of all-cause mortality (random-effects: meta-HR 0.72, 95 % CI 0.65-0.80), 23 % decreased risk of major adverse cardiovascular events (fixed-effects: meta-HR 0.72, 95 % CI 0.62-0.83). Subgroup analysis of patients with rheumatoid arthritis showed similar results (fixed-effects: meta-HR 0.77, 95 % CI 0.67-0.89 for all-cause mortality; meta-HR 0.75, 95 % CI 0.63-0.88 for major adverse cardiovascular events). Furthermore, the protective role of statin in decreasing mortality was stronger in patients receiving statin for primary prevention of cardiovascular diseases than that for secondary prevention (fixed-effects: meta-HR 0.64, 95 % CI 0.59-0.70; meta-HR 0.84, 95 % CI 0.80-0.89, respectively), although both were statistically significant. Additional analysis yielded similar benefit from statin usage between females and males regarding mortality. Conclusion Statin use was associated with lower risks of mortality and cardiovascular events, with greater benefits for primary prevention in those IMIDs patients without prior cardiovascular disease.