Mansi Ishak A, Frei Christopher R, Halm Ethan A, Mortensen Eric M
1 Department of Medicine, VA North Texas Health Care System, Dallas, TX, USA.
2 Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA.
Vascular. 2017 Aug;25(4):372-381. doi: 10.1177/1708538116684942. Epub 2016 Dec 20.
Objectives Prior studies examining the effects of statins on arterial aneurysm development and progression yielded conflicting results due to their smaller size and presence of residual confounders. The objective of this study is to examine the association of statins with risk of being diagnosed with aortic, peripheral, and visceral artery aneurysm. Methods This was a retrospective cohort study of Tricare enrollees (from 1 October 2003 to 31 March 2012). Main outcomes were diagnosis of aortic, peripheral, or visceral artery aneurysm and undergoing aortic aneurysm repair procedure during follow-up period. Using 115 baseline characteristics, we generated a propensity score to match statin users and nonusers and examine the odds of outcomes (primary analysis). Secondary analysis examined outcomes at various subcohorts. Results Out of 10,910 statin users and 49,545 nonusers, we propensity score-matched 6728 pairs of statin users and nonusers. Statin users and nonusers had similar odds of being diagnosed with aortic, peripheral, and visceral artery aneurysms (odds ratio [OR]: 1.06, 95% confidence interval [95% CI]: 0.85-1.33) and of undergoing aortic aneurysm repair procedures (OR: 0.54, 95% CI: 0.22-1.35). Secondary analysis showed a tendency toward fewer aortic aneurysm procedures among statin users that did not reach statistical significance. However, high-intensity statin users in comparison to non-intensive statin users had higher adjusted odds of aortic, peripheral, and visceral artery aneurysms (OR: 1.76, 95% CI: 1.37-2.25, p < .0001). Conclusions This study does not support a clinically significant benefit or harm from statins regarding development of arterial aneurysm. However, secondary analyses may support the hypothesis proposed by previous research proposing a bidirectional role for statins.
目的 先前研究他汀类药物对动脉动脉瘤发生和发展的影响时，由于样本量较小且存在残余混杂因素，结果相互矛盾。本研究的目的是检验他汀类药物与被诊断为主动脉、外周和内脏动脉瘤风险之间的关联。方法 这是一项对Tricare参保者的回顾性队列研究（从2003年10月1日至2012年3月31日）。主要结局是在随访期间被诊断为主动脉、外周或内脏动脉瘤以及接受主动脉瘤修复手术。利用115项基线特征，我们生成了一个倾向评分，以匹配他汀类药物使用者和非使用者，并检验结局的比值比（主要分析）。次要分析检查了各个亚组的结局。结果 在10910名他汀类药物使用者和49545名非使用者中，我们通过倾向评分匹配了6728对他汀类药物使用者和非使用者。他汀类药物使用者和非使用者被诊断为主动脉、外周和内脏动脉瘤的比值比相似（比值比[OR]：1.06，95%置信区间[95%CI]：0.85 - 1.33），接受主动脉瘤修复手术的比值比也相似（OR：0.54，95%CI：0.22 - 1.35）。次要分析显示，他汀类药物使用者中主动脉瘤手术例数有减少的趋势，但未达到统计学意义。然而，与非高强度他汀类药物使用者相比，高强度他汀类药物使用者主动脉、外周和内脏动脉瘤的调整后比值比更高（OR：1.76，95%CI：1.37 - 2.25，p <.0001）。结论 本研究不支持他汀类药物在动脉动脉瘤发生方面具有临床上显著的益处或危害。然而，次要分析可能支持先前研究所提出的他汀类药物具有双向作用的假设。
