Statin use is associated with lower risk of dementia in stroke patients: a community-based cohort study with inverse probability weighted marginal structural model analysis.
Statin use is associated with lower risk of dementia in stroke patients: a community-based cohort study with inverse probability weighted marginal structural model analysis.
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DOI：
10.1007/s10654-022-00856-7
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发表时间：
2022-06
影响因子：
13.6
通讯作者：
Mant, Jonathan
中科院分区：
文献类型：
--
作者：
Yang, Zhirong;Toh, Sengwee;Li, Xiaojuan;Edwards, Duncan;Brayne, Carol;Mant, Jonathan
目前的证据对于他汀类药物对患有痴呆症高风险的中风患者的认知益处或危害尚无定论。这项观察性队列研究利用临床实践研究数据链的数据调查了他汀类药物的使用与中风后痴呆之间的关联。对既往没有痴呆症、发生过中风但前一年未接受他汀类药物治疗的患者进行长达 10 年的随访。我们使用逆概率加权边际结构模型来估计意向治疗（ITT，开始使用他汀类药物与不开始使用他汀类药物）和按方案（PP，持续使用他汀类药物与不使用他汀类药物）对痴呆风险的观察类比影响。为了探索未测量的混杂因素的潜在影响，我们检查了冠心病（CHD，阳性对照结果）、骨折和消化性溃疡（阴性对照结果）的风险。在 18,577 名他汀类药物起始者和 14,613 名非起始者（平均随访 4.2 年）中，ITT 分析中痴呆症的调整后风险比 (aHR) 为 0.70（95% 置信区间 [CI] 0.64-0.75），PP 分析中为 0.55（95% CI 0.50-0.62）。相应的 aHRITT 和 aHRPP 对于 CHD 为 0.87 (95% CI 0.79–0.95) 和 0.70 (95% CI 0.62–0.80)，对于消化性溃疡为 1.03 (95% CI 0.82–1.29) 和 1.09 (95% CI 0.77–1.54)，对于 0.88 (95% CI 0.80–0.96) 和 0.86 (95% CI 0.75–0.98) 骨折。中风后开始使用他汀类药物与痴呆症风险较低相关，对于长期坚持使用他汀类药物的患者可能有更大的益处。观察到的他汀类药物使用与中风后痴呆之间的关联可能部分被高估，因为他汀类药物使用与骨折之间的关联存在未测量的混杂因素。在线版本包含可在 10.1007/s10654-022-00856-7 获取的补充材料。
Current evidence is inconclusive on cognitive benefits or harms of statins among stroke patients, who have high risk of dementia. This observational cohort study investigated the association between statin use and post-stroke dementia using data from the Clinical Practice Research Datalink. Patients without prior dementia who had an incident stroke but received no statins in the preceding year were followed for up to 10 years. We used inverse probability weighted marginal structural models to estimate observational analogues of intention-to-treat (ITT, statin initiation vs. no initiation) and per-protocol (PP, sustained statin use vs. no use) effects on the risk of dementia. To explore potential impact of unmeasured confounding, we examined the risks of coronary heart disease (CHD, positive control outcome), fracture and peptic ulcer (negative control outcomes). In 18,577 statin initiators and 14,613 non-initiators (mean follow-up of 4.2 years), the adjusted hazard ratio (aHR) for dementia was 0.70 (95% confidence interval [CI] 0.64–0.75) in ITT analysis and 0.55 (95% CI 0.50–0.62) in PP analysis. The corresponding aHRITT and aHRPP were 0.87 (95% CI 0.79–0.95) and 0.70 (95% CI 0.62–0.80) for CHD, 1.03 (95% CI 0.82–1.29) and 1.09 (95% CI 0.77–1.54) for peptic ulcer, and 0.88 (95% CI 0.80–0.96) and 0.86 (95% CI 0.75–0.98) for fracture. Statin initiation after stroke was associated with lower risk of dementia, with a potentially greater benefit in patients who persisted with statins over time. The observed association of statin use with post-stroke dementia may in part be overestimated due to unmeasured confounding shared with the association between statin use and fracture. The online version contains supplementary material available at 10.1007/s10654-022-00856-7.
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影响因子：
29
作者：
Biffi A;Bailey D;Anderson CD;Ayres AM;Gurol EM;Greenberg SM;Rosand J;Viswanathan A
通讯作者：
Viswanathan A
影响因子：
5
作者：
Cole, Stephen R.;Hernan, Miguel A.
通讯作者：
Hernan, Miguel A.
影响因子：
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Amarenco, Pierre;Goldstein, Larry B.;Welch, K. Michael A.
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Welch, K. Michael A.
影响因子：
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作者：
Grundy, Scott M.;Stone, Neil J.;Yeboah, Joseph
通讯作者：
Yeboah, Joseph
影响因子：
5.3
作者：
Mach, Francois;Baigent, Colin;Patel, Riyaz S.
通讯作者：
Patel, Riyaz S.