S1622 Comparative Effectiveness of Statins in Inflammatory Bowel Disease: A Propensity Score-Matched Real-World Study

Introduction: While statins are known for their cardioprotective benefits, limited data exist comparing individual agents within the same intensity class in patients with Inflammatory Bowel Disease (IBD). This study assessed the comparative effectiveness of rosuvastatin and atorvastatin (high-intensity statins), as well as simvastatin and pravastatin (low-/moderate-intensity statins), on mortality and acute arterial events, including Atherosclerotic Cardiovascular Disease (ASCVD)—which comprises Coronary Heart Disease (CHD) and Cerebrovascular Disease (CVD)—and Peripheral Arterial Disease (PAD), among patients with IBD, Crohn’s disease (CD), and ulcerative colitis (UC). Methods: This retrospective, propensity score–matched cohort study utilized real-world data to compare rosuvastatin with atorvastatin and simvastatin with pravastatin across IBD, CD, and UC populations. Patients were matched on demographics, components of the Charlson Comorbidity Index, indicators of IBD severity, and ASCVD risk factors. Cox proportional hazards models were used to estimate hazard ratios (HRs) for all-cause mortality, CVD, CHD, and PAD. Results: Among high-intensity statins, rosuvastatin was associated with significantly lower all-cause mortality compared to atorvastatin in IBD (HR 0.73, P < 0.001), CD (HR 0.70, P < 0.001), and UC (HR 0.70, P < 0.001). Rosuvastatin also conferred greater reduction in CVD, CHD, and showed a non-significant trend toward lower PAD. Additionally, rosuvastatin was associated with a significantly lower risk of composite ASCVD outcomes in IBD (HR 0.65), CD (HR 0.61), and UC (HR 0.67), all P < 0.001. In the low-/moderate-intensity group, all-cause mortality was similar between simvastatin and pravastatin in IBD (HR 0.97, P = 0.53), CD (HR 1.04, P = 0.61), and UC (HR 0.97, P = 0.54), though simvastatin was associated with modest improvements in CVD and CHD outcomes, as well as significantly lower composite ASCVD outcomes in IBD (HR 0.74), CD (HR 0.70), and UC (HR 0.79), all P < 0.001. Conclusion: In this real-world analysis, rosuvastatin was more effective than atorvastatin in reducing all-cause mortality and acute arterial events—including composite ASCVD outcomes—in IBD patients. Simvastatin and pravastatin demonstrated comparable all-cause mortality outcomes, with a possible vascular benefit favoring simvastatin, including significantly lower composite ASCVD risks. These within-class differences may guide statin selection in IBD patients with elevated cardiovascular risk.