General Dynamics Information Technology, Defense and Veterans Brain Injury Center, Fairfax, Virginia (Dr Khokhar); Department of Pharmaceutical Health Services Research, University of Maryland School of Pharmacy, Baltimore (Drs Slejko, Perfetto, and Simoni-Wastila); National Health Council, Washington, District of Columbia (Dr Perfetto); Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore (Dr Zhan and Mr Smith); and West Virginia University School of Public Health, Morgantown (Mr Smith).
J Head Trauma Rehabil. 2018 Nov/Dec;33(6):E68-E76. doi: 10.1097/HTR.0000000000000369.
To assess the relationship between posttraumatic brain injury statin use and (1) mortality and (2) the incidence of associated morbidities, including stroke, depression, and Alzheimer's disease and related dementias following injury.
Nested cohort of all Medicare beneficiaries 65 years of age and older who survived a traumatic brain injury (TBI) hospitalization during 2006 through 2010. The final sample comprised 100 515 beneficiaries.
Retrospective cohort study of older Medicare beneficiaries. Relative risks (RR) and 95% confidence interval (CI) were obtained using discrete time analysis and generalized estimating equations.
The exposure of interest included monthly atorvastatin, fluvastatin, lovastatin, pravastatin, rosuvastatin, and simvastatin use. Outcomes of interest included mortality, stroke, depression, and Alzheimer's disease and related dementias.
Statin use of any kind was associated with decreased mortality following TBI hospitalization discharge. Any statin use was also associated with a decrease in any stroke (RR, 0.86; 95% confidence intervals (CI), 0.81-0.91), depression (RR, 0.85; 95% CI, 0.79-0.90), and Alzheimer's disease and related dementias (RR, 0.77; 95% CI, 0.73-0.81).
These findings provide valuable information for clinicians treating older adults with TBI as clinicians can consider, when appropriate, atorvastatin and simvastatin to older adults with TBI in order to decrease mortality and associated morbidities.
评估颅脑损伤后使用他汀类药物与（1）死亡率和（2）与损伤相关的发病率之间的关系，包括脑卒中、抑郁症、阿尔茨海默病及相关痴呆。
对所有在 2006 年至 2010 年期间存活下来的患有创伤性脑损伤（TBI）住院治疗的 Medicare 受益人的嵌套队列进行了研究。最终样本包括 100515 名受益人。
对老年 Medicare 受益人的回顾性队列研究。采用离散时间分析和广义估计方程获得相对风险（RR）和 95%置信区间（CI）。
感兴趣的暴露因素包括阿托伐他汀、氟伐他汀、洛伐他汀、普伐他汀、罗苏伐他汀和辛伐他汀的每月使用情况。感兴趣的结局包括死亡率、脑卒中、抑郁症和阿尔茨海默病及相关痴呆。
TBI 住院出院后，任何类型的他汀类药物的使用都与死亡率降低有关。任何他汀类药物的使用也与任何脑卒中（RR，0.86；95%置信区间（CI），0.81-0.91）、抑郁症（RR，0.85；95% CI，0.79-0.90）和阿尔茨海默病及相关痴呆（RR，0.77；95% CI，0.73-0.81）的减少相关。
这些发现为治疗 TBI 老年患者的临床医生提供了有价值的信息，因为临床医生可以考虑在适当情况下向 TBI 老年患者使用阿托伐他汀和辛伐他汀，以降低死亡率和相关发病率。
