Avoiding Statins in Dermatomyositis/Polymyositis Increases Mortality

Increased Mortality in Dermatomyositis Patients Not Using Statins

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I was interested to read a report from authors at Thomas Jefferson University which helped clarify some of the issues regarding whether patients with autoimmune muscle diseases should be given statins. The concern centers, in part, around the possibility that statins increase the risk of myopathy. So using a drug that might cause muscle problems in a patient with muscle problems or at risk for muscle problems is an obvious concern.

The researchers looked back at about 10 years of anonymized US health data from a database. They included patients in their study who were diagnosed with hyperlipidemia after being diagnosed with dermatomyositis or polymyositis or rheumatoid arthritis. The US researchers then compared statin initiation rates and mortality outcomes.

Results

The authors found 33,000 rheumatoid arthritis patients with hyperlipdemia and 1079 dermatomyositis/polymyositis patients with hyperlipidemia. Rheumatoid arthritis patients with high lipids were much more likely to be prescribed a statin than dermatomyositis/polymyositis patients (27.4% vs 17.91 %, p<0.0001). Importantly, the dermatomyositis/polymyositis “statin” users were shown to have a reduced mortality rate (75 deaths/1000/year) compared to “non-statin” users 147 deaths/1000/year (p = 0.0273, HR = 0.515, CI 0.28-0.93). CPK muscle enzymes were similar in dermatomyositis/polymyositis “statin” users and non statin users.

Discussion

This was an interesting and valuable study. I see many patients with dermatomyositis and have become involved in this very discussion about statin initiation many times. Although I’m not generally the doctor prescribing the statin, I’m often asked to weigh in on my thoughts. This paper shows us that we need to address the cardiovascular risk of our dermatomyositis patients a little more aggressively perhaps than we do now. The authors here call for patient-centric cardiovascular guidelines for patients with dermatomyositis and polymyositis who have elevated lipids. Withholding statin therapy due to fear of worsening or triggering muscle disease is probably not the way to go for most patients - and may even increase mortality.

REFERENCE

Fares J et al. Low utilization of statins in patients with dermatomyositis/polymyositis and hyperlipidemia: a multicenter USA-based study (2013-2023). Clin Rheumatol. 2023 Nov 6. doi: 10.1007/s10067-023-06801-7. Online ahead of print.