Persistence with Statins and Onset of Rheumatoid Arthritis A Population-Based Cohort Study 英文参考文献.docVIP
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Persistence with Statins and Onset of Rheumatoid Arthritis A Population-Based Cohort Study 英文参考文献
PersistencewithStatinsandOnsetofRheumatoid
Arthritis:APopulation-BasedCohortStudy
GabrielChodick1,2.*, HowardAmital2,3.,YoavShalem2,EhudKokia1,AnthonyD.Heymann1,2 ,Avi
Porath1,4,VardaShalev1,2
1MaccabiHealthcareServices,TelAviv,Israel,2SacklerFacultyofMedicine,TelAvivUniversity,TelAviv,Israel,3DepartmentofMedicineD,MeirMedicalCenter,Kefar
Saba,Israel,4FacultyofHealthSciences,BenGurionUniversityoftheNegev,Israel
Abstract
Background:Thebeneficialeffectsofstatinsinrheumatoidarthritis(RA)havebeensuggestedpreviously,butitisunclear
whetherstatinsmaypreventitsdevelopment.Theaimofthisretrospectivecohortstudywastoexplorewhetherpersistent
useofstatinsisassociatedwithonsetofRA.
MethodsandFindings:ThecomputerizedmedicaldatabasesofalargehealthorganizationinIsraelwereusedtoidentify
diagnosedRAcasesamongadultswhobeganstatintherapybetween1998and2007.Persistencewithstatinswasassessed
bycalculatingthemeanproportionoffollow-updayscovered(PDC)withstatinsforeverystudyparticipant.Toassessthe
possibleeffectsofhealthyuserbias,wealsoexaminedtheriskofosteoarthritis(OA),acommondegenerativejointdisease
thatisunlikelytobeaffectedbyuseofstatins. Atotalof211,627and193,770individualswereeligiblefortheRAandOA
cohortanalyses,respectively.Duringthestudyfollow-upperiod,therewere2,578incidentRAcases(3.07per1,000person-
years) and 17,878 incident OA cases (24.34 per 1,000 person-years). The crude incidence density rate of RA among
nonpersistentpatients(PDClevelof,20%)was51%higher(3.89per1,000person-years)comparedtohighlypersistent
patientswhowerecoveredwithstatinsforatleast80%ofthefollow-upperiod.Afteradjustmentforpotentialconfounders,
highly persistent patients had a hazard ratio of 0.58 (95% confidence interval 0.52–0.65) for RA compared with
nonpersistentpatients.Largerdifferenceswereobservedinyoungerpatientsandinpatientsinitiatingtreatmentwithhigh
efficacystatins.IntheOAcohortanalysis,highpersistencewithstatinswasassociatedonlywithamodestdecrementinrisk
ratio(hazardratio=0.85;0.81–0.88)compar
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