Preventing Thyroid Eye Disease with Statins: Evidence from a Meta-Analysis.

Abstract

Statins, a class of medications that inhibit 3-hydroxy-3-methylglutaryl coenzyme A reductase, are the first-line treatment for cholesterol reduction. Beyond their anti-lipidemic properties, statins have gained recent attention for their anti-inflammatory effects. Recently, it has been shown that when prescribed early in the course of Graves' disease, there appears to be a reduction in the progression toward thyroid eye disease. This study aims to provide an overall estimate of the effect of statin therapy in relation to the development of thyroid eye disease by conducting a meta-analysis. Both CINAHL and MEDLINE databases were used to screen for studies without a time-restricted period. Studies had to include a control (no statin therapy) and treatment group (received statin therapy) with patients at baseline harboring a diagnosis of Graves' disease. Studies had to provide a hazard (or odds) ratio (HR or OR) and 95% confidence intervals, which were subsequently combined using the generic inverse variance method. Six studies were ultimately included in the meta-analysis (from an initial n = 28 studies identified). A pooled meta-analysis demonstrated a significantly reduced hazard ratio of developing thyroid eye disease in patients treated with statin therapy (HR 0.57; 95% CI 0.44-0.74, p < 0.05). Significant heterogeneity was present in our study (I² = 87.8%). This is the first meta-analysis to provide an overall estimate of the beneficial effects of statins toward preventing the development of thyroid eye disease in patients with Graves' disease. The exact mechanism remains unknown but is believed to be an extra-lipidemic manifestation, relating to the anti-inflammatory properties of the statin medications. Further studies are required to confirm our findings and identify optimal candidates for early initiation of statin therapy in Graves' disease.