Statin use and risk of community acquired pneumonia in older people: population based case-control study.
Statin use and risk of community acquired pneumonia in older people: population based case-control study.
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DOI：
10.1136/bmj.b2137
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发表时间：
2009-06-16
期刊：
影响因子：
--
通讯作者：
Jackson LA
中科院分区：
文献类型：
--
作者：
Dublin S;Jackson ML;Nelson JC;Weiss NS;Larson EB;Jackson LA
目的验证羟甲基戊二酰辅酶A还原酶抑制剂（他汀类药物）可能降低社区获得性肺炎风险的假设。设计基于人群的病例对照研究。设置集团健康，一个大型的综合医疗保健服务系统。人口免疫能力，社区居住65至94岁的健康小组成员;每个肺炎病例有两个匹配的对照组。共病、功能和认知状态、他汀类药物使用与肺炎风险之间相关性的潜在混杂因素的信息来自病历审查和计算机化药房数据。主要结果测量与当前他汀类药物使用相关的肺炎风险的校正估计值。结果1125例肺炎确诊病例和2235例对照。与对照组相比，病例更可能患有慢性肺和心脏病，特别是严重疾病，以及功能或认知障碍。16.1%（181/1125）的病例和14.6%（327/2235）的对照组目前使用他汀类药物（校正比值比1.26，95%置信区间1.01 - 1.56）。在住院病例和匹配的对照组中，目前使用他汀类药物的病例为17.2%（68/395），对照组为14.2%（112/788）（与未使用相比，调整后的比值比为1.61，1.08至2.39）。在他汀类药物适用于二级预防的人群中，与当前使用他汀类药物相关的肺炎风险的调整比值比为1.25（0.94至1.67）;在没有此类适应症的人群中，为0.81（0.46至1.42）。结论：在免疫功能正常的社区老年人中，他汀类药物的使用与肺炎风险的降低无关。以前的研究结果可能反映了“健康用户”的偏见。
Objective To test the hypothesis that hydroxymethyl glutaryl coenzyme A reductase inhibitors (statins) may decrease the risk of community acquired pneumonia. Design Population based case-control study. Setting Group Health, a large integrated healthcare delivery system. Population Immunocompetent, community dwelling Group Health members aged 65 to 94; two matched controls for each case with pneumonia. Information on comorbid illnesses and functional and cognitive status, potential confounders of the association between statin use and risk of pneumonia, came from medical record review and computerised pharmacy data. Main outcome measure Adjusted estimates of risk of pneumonia in relation to current statin use. Results 1125 validated cases of pneumonia and 2235 matched controls were identified. Compared with controls, cases were more likely to have chronic lung and heart disease, especially severe disease, and functional or cognitive impairment. Current statin use was present in 16.1% (181/1125) of cases and 14.6% (327/2235) of controls (adjusted odds ratio 1.26, 95% confidence interval 1.01 to 1.56). Among cases admitted to hospital and matched controls, current statin use was present in 17.2% (68/395) of cases and 14.2% (112/788) of controls (adjusted odds ratio 1.61, 1.08 to 2.39, compared with non-use). In people in whom statins were indicated for secondary prevention, the adjusted odds ratio for risk of pneumonia in relation to current statin use was 1.25 (0.94 to 1.67); in those with no such indication, it was 0.81 (0.46 to 1.42). Conclusions Statin use was not associated with decreased risk of pneumonia among immunocompetent, community dwelling older people. Findings of previous studies may reflect “healthy user” bias.
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