Federico Rea1, Stefano Bonassi2,3, Cristiana Vitale4, Gianluca Trifirò5, Silvia Cascini6, Giuseppe Roberto7, Alessandro Chinellato8, Ersilia Lucenteforte9, Alessandro Mugelli9, Giovanni Corrao1. 1. Laboratory of Healthcare Research & Pharmacoepidemiology, Unit of Biostatistics, Epidemiology and Public Health, Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Milan, Italy. 2. Department of Human Sciences and Quality of Life Promotion, San Raffaele University, Rome, Italy. 3. Unit of Clinical and Molecular Epidemiology, IRCCS San Raffaele Pisana, Rome, Italy. 4. Department of Medical Sciences, IRCCS San Raffaele Pisana, Rome, Italy. 5. Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Messina, Italy. 6. Department of Epidemiology, Lazio Regional Health Service, Rome, Italy. 7. Epidemiology Unit, Regional Agency for Healthcare Services of Tuscany, Florence, Italy. 8. Treviso Local Health Unit, Treviso, Italy. 9. Department of Neurosciences, Psychology, Drug Research and Children's Health, University of Florence, Florence, Italy.
Abstract
PURPOSE: Conflicting findings were observed from clinical trials and observational studies evaluating the association between the use of statins and the risk of fracture. A case-control study nested into a cohort of elderly patients on treatment with statins for cardiovascular secondary prevention was performed on this issue. METHODS: The cohort was formed by 13 875 individuals aged ≥65 years from several Italian health units receiving statins after hospital discharge for cardiovascular outcomes. From this cohort, 964 patients who experienced fracture were identified (i.e., cases). Up to five controls were randomly selected for each case from the underlying cohort. Conditional logistic regression was used to model the risk of fracture associated with adherence to statins, which was measured from the proportion of days covered (PDC) by treatment. A set of sensitivity analyses was performed in order to account for sources of systematic uncertainty. RESULTS: Compared with patients with low adherence (PDC ≤ 40%), those on intermediate (PDC 41-80%) and high (PDC > 80%) adherence exhibited a risk reduction of 21% (95% confidence interval 6% to 23%) and 25% (7% to 40%). Similar effects were observed among patients younger and older than 80 years, as well as among men, while there was no evidence that adherence to statins affected the risk of fracture among women. Sensitivity analyses revealed that the associations were consistent and robust. CONCLUSIONS: Use of statins for secondary cardiovascular prevention is associated with fracture risk reduction in elderly people. Further studies are required to better clarify the statin-fracture association in postmenopausal women.
PURPOSE: Conflicting findings were observed from clinical trials and observational studies evaluating the association between the use of statins and the risk of fracture. A case-control study nested into a cohort of elderly patients on treatment with statins for cardiovascular secondary prevention was performed on this issue. METHODS: The cohort was formed by 13 875 individuals aged ≥65 years from several Italian health units receiving statins after hospital discharge for cardiovascular outcomes. From this cohort, 964 patients who experienced fracture were identified (i.e., cases). Up to five controls were randomly selected for each case from the underlying cohort. Conditional logistic regression was used to model the risk of fracture associated with adherence to statins, which was measured from the proportion of days covered (PDC) by treatment. A set of sensitivity analyses was performed in order to account for sources of systematic uncertainty. RESULTS: Compared with patients with low adherence (PDC ≤ 40%), those on intermediate (PDC 41-80%) and high (PDC > 80%) adherence exhibited a risk reduction of 21% (95% confidence interval 6% to 23%) and 25% (7% to 40%). Similar effects were observed among patients younger and older than 80 years, as well as among men, while there was no evidence that adherence to statins affected the risk of fracture among women. Sensitivity analyses revealed that the associations were consistent and robust. CONCLUSIONS: Use of statins for secondary cardiovascular prevention is associated with fracture risk reduction in elderly people. Further studies are required to better clarify the statin-fracture association in postmenopausal women.
Authors: Kyoung Jin Kim; Jimi Choi; Ji Yoon Kim; Jae Hyun Bae; Kyeong Jin Kim; Hee Young Kim; Hye Jin Yoo; Ji A Seo; Nan Hee Kim; Kyung Mook Choi; Sei Hyun Baik; Sin Gon Kim; Nam Hoon Kim Journal: J Lipid Atheroscler Date: 2021-07-06
Authors: Lachlan L Dalli; Monique F Kilkenny; Isabelle Arnet; Frank M Sanfilippo; Doyle M Cummings; Moira K Kapral; Joosup Kim; Jan Cameron; Kevin Y Yap; Melanie Greenland; Dominique A Cadilhac Journal: Br J Clin Pharmacol Date: 2022-05-22 Impact factor: 3.716
Authors: Mirjam Hempenius; Kim Luijken; Anthonius de Boer; Olaf Klungel; Rolf Groenwold; Helga Gardarsdottir Journal: Pharmacoepidemiol Drug Saf Date: 2020-05-11 Impact factor: 2.890