Do statins affect risk Do statins affect risk of pneumonia in the of pneumonia in the general population: general population: nested case control nested case control study study Yana Vinogradova Yana Vinogradova Julia Hippisley-Cox Julia Hippisley-Cox Calgary Calgary 2007 2007
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Do statins affect risk of pneumonia in the general population: nested case control study
Do statins affect risk of pneumonia in the general population: nested case control study. Yana Vinogradova Julia Hippisley-Cox Calgary 2007. Aims of presentation. Research study Present analysis of study determining the risk of community acquired pneumonia in patients taking statins. - PowerPoint PPT Presentation
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Do statins affect risk of Do statins affect risk of pneumonia in the general pneumonia in the general
population: nested case control population: nested case control studystudy
Yana VinogradovaYana VinogradovaJulia Hippisley-Cox Julia Hippisley-Cox
CalgaryCalgary20072007
Aims of presentationAims of presentation
Research study Research study – Present analysis of study determining the
risk of community acquired pneumonia in patients taking statins
Background to pneumonia Background to pneumonia statin analysis statin analysis
• Some evidence from lab data that Some evidence from lab data that statins benefit in case of infectious statins benefit in case of infectious diseasesdiseases
• Statins can reduce rate of severe Statins can reduce rate of severe sepsis and ICU admissionsepsis and ICU admission
• Significant reduction in mortalitySignificant reduction in mortality
• Reduction in fatal pneumonia riskReduction in fatal pneumonia risk
• 51% reduction in diabetes patients51% reduction in diabetes patients
Study population: Study population: QRESEARCH databaseQRESEARCH database
• Currently largest database in the UKCurrently largest database in the UK• 537 UK practices537 UK practices• > 6 practices in every Strategic Health > 6 practices in every Strategic Health
Authority (administrative area)Authority (administrative area)• > 9 million patients including those who > 9 million patients including those who
died, left and still registereddied, left and still registered• > 30 million person years of observation> 30 million person years of observation
Data source: Data source: QRESEARCH databaseQRESEARCH database
• Longitudinal data for 15+ yearsLongitudinal data for 15+ years
• Derived from GP clinical recordsDerived from GP clinical records
• Validated against external and internal Validated against external and internal measuresmeasures
• Industry independent Industry independent
Study design & settingStudy design & setting
• Nested case control studyNested case control study• Study period Jan 1996-Dec 2005 Study period Jan 1996-Dec 2005 • Cases were incident community-Cases were incident community-
acquired pneumonia patientsacquired pneumonia patients• 5 controls matched by 5 controls matched by
– Age– Sex– Practice– Calendar year
Assessment of exposureAssessment of exposureanalysis restricted to subjects with at least 2 years of analysis restricted to subjects with at least 2 years of
prescribing dataprescribing data
• useuse:: at least 2 script in 12 months prior to the index date
• different types of statinsdifferent types of statinsatorvastatin pravastatin cerivastatinsimvastatin fluvastatin rosuvastatin
• time for the last prescriptiontime for the last prescription: : 28 days29-89 days90-365 days
all patientsAdjusted odds ratios and 95% confidence intervals for additional risk group
Use of statin in the last 12 monthsUse of statin in the last 12 months
Cases Cases
N=17,757N=17,757
ControlsControls
N=80,487N=80,487
Unadjusted Unadjusted Odds RatioOdds Ratio
(95% CI)(95% CI)
Adjusted Adjusted Odds Ratio Odds Ratio
(95% CI)(95% CI) 2,244 2,244
(12.6%)(12.6%)
8,7888,788
(10.9%)(10.9%)
1.241.24
(1.18 – 1.31)(1.18 – 1.31)
0.820.82
(0.77 – 0.87)(0.77 – 0.87)
Adjusted for socio-economic status, body-mass index, Adjusted for socio-economic status, body-mass index, smoking status, use of influenza and pneumococcal smoking status, use of influenza and pneumococcal vaccinations and the co-morbidities vaccinations and the co-morbidities
• Misclassification bias: no x-ray or Misclassification bias: no x-ray or microbiological confirmationmicrobiological confirmation
• Misclassification of use: over-the-Misclassification of use: over-the-counter purchasecounter purchase
• Data contain information on Data contain information on prescription, not actual useprescription, not actual use
• Information on certain risk factors Information on certain risk factors (alcohol intake) (alcohol intake)
• Missing data for BMI, smokingMissing data for BMI, smoking
ConclusionsConclusions
• Recent use of statin is associated with Recent use of statin is associated with reduced risk of community acquired reduced risk of community acquired pneumoniapneumonia