Group Health Research Institute, Seattle, WA 98101-1448, USA.
Pharmacoepidemiol Drug Saf. 2012 Nov;21(11):1173-82. doi: 10.1002/pds.3340. Epub 2012 Sep 5.
To test whether angiotensin-converting enzyme (ACE) inhibitor use is associated with decreased risk of community-acquired pneumonia in older adults.
We analyzed data from a nested case-control study of community-dwelling, immunocompetent adults aged 65-94 within an integrated healthcare delivery system. Cases of ambulatory and hospitalized pneumonia from 2000 to 2003 were identified from International Classification of Disease, version 9, codes and validated using medical record review. Controls were matched to cases by age, sex, and calendar year. Using health plan pharmacy data, we defined current use as filling ≥2 prescriptions during the 180 days prior to the case's diagnosis date. We calculated standardized doses per day using World Health Organization defined daily doses. Multivariable conditional logistic regression estimated adjusted odds ratios (ORs) for pneumonia in relation to ACE inhibitor use, adjusting for comorbidity, functional and cognitive status, and other covariates from medical record review and pharmacy data.
Current use of ACE inhibitors was seen in 23% (242/1039) of cases and 21% (433/2022) of controls. Lisinopril accounted for 95% of prescriptions. The OR for pneumonia comparing current use to no current use was 0.99 (95% confidence interval [CI] 0.83-1.19). The OR for use of more than two standardized daily doses per day was 1.39 (95% CI 0.93-2.06) compared to no current use.
ACE inhibitor use is not associated with reduced pneumonia risk in community-dwelling older adults.
检验血管紧张素转换酶（ACE）抑制剂的使用是否与老年人社区获得性肺炎风险降低相关。
我们分析了一个综合医疗服务系统中，65-94 岁社区居住、免疫功能正常的成年人的嵌套病例对照研究的数据。2000 年至 2003 年期间，通过国际疾病分类第 9 版代码识别出门诊和住院肺炎病例，并通过病历审查进行验证。对照病例按年龄、性别和日历年份进行匹配。使用健康计划药房数据，我们将当前使用定义为在病例诊断日期前 180 天内≥2 次处方。我们使用世界卫生组织定义的日剂量计算了每天的标准化剂量。多变量条件逻辑回归估计了 ACE 抑制剂使用与肺炎之间的调整后比值比（OR），调整了病历审查和药房数据中的合并症、功能和认知状态以及其他协变量。
当前使用 ACE 抑制剂的病例占 23%（242/1039），对照占 21%（433/2022）。赖诺普利占处方的 95%。与无当前使用相比，当前使用 ACE 抑制剂的肺炎 OR 为 0.99（95%置信区间[CI]0.83-1.19）。与无当前使用相比，每日使用超过两个标准化剂量的 OR 为 1.39（95%CI0.93-2.06）。
在社区居住的老年人群中，ACE 抑制剂的使用与肺炎风险降低无关。
