Khokhar Bilal, Simoni-Wastila Linda, Slejko Julia F, Perfetto Eleanor, Zhan Min, Smith Gordon S
General Dynamics Health Solutions, Defense and Veterans Brain Injury Center, Silver Spring, MD, USA.
University of Maryland, Baltimore, MD, USA.
J Pharm Technol. 2017 Dec;33(6):225-236. doi: 10.1177/8755122517735656. Epub 2017 Oct 12.
Traumatic brain injury (TBI) is a significant public health concern for older adults. Small-scale human studies have suggested pre-TBI statin use is associated with decreased in-hospital mortality following TBI, highlighting the need for large-scale translational research.
To investigate the relationship between pre-TBI statin use and in-hospital mortality following TBI.
A retrospective study of Medicare beneficiaries 65 and older hospitalized with a TBI during 2006 to 2010 was conducted to assess the impact of pre-TBI statin use on in-hospital mortality following TBI. Exposure of interest included atorvastatin, fluvastatin, lovastatin, pravastatin, rosuvastatin, and simvastatin. Beneficiaries were classified as current, recent, past, and nonusers of statins prior to TBI. The outcome of interest was in-hospital mortality. Logistic regression was used to obtain odds ratios (ORs) and 95% confidence intervals (CIs) comparing current, recent, and prior statin use to nonuse.
Most statin users were classified as current users (90%). Current atorvastatin (OR = 0.88; 95% = CI 0.82, 0.96), simvastatin (OR = 0.84; 95% CI = 0.79, 0.91), and rosuvastatin (OR = 0.79; 95% CI = 0.67, 0.94) use were associated with a significant decrease in the risk of in-hospital mortality following TBI.
In addition to being the most used statins, current use of atorvastatin, rosuvastatin, and simvastatin was associated with a significant decrease in in-hospital mortality following TBI among older adults. Future research must include clinical trials to help exclude the possibility of a healthy user effect in order to better understand the impact of statin use on in-hospital mortality following TBI.
创伤性脑损伤（TBI）是老年人群中一个重大的公共卫生问题。小规模的人体研究表明，创伤性脑损伤前使用他汀类药物与创伤性脑损伤后住院死亡率降低有关，这凸显了大规模转化研究的必要性。
探讨创伤性脑损伤前使用他汀类药物与创伤性脑损伤后住院死亡率之间的关系。
对2006年至2010年期间因创伤性脑损伤住院的65岁及以上医疗保险受益人群进行回顾性研究，以评估创伤性脑损伤前使用他汀类药物对创伤性脑损伤后住院死亡率的影响。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、瑞舒伐他汀和辛伐他汀。将受益人分为创伤性脑损伤前他汀类药物的当前使用者、近期使用者、过去使用者和非使用者。感兴趣的结局是住院死亡率。使用逻辑回归来获得比值比（OR）和95%置信区间（CI），以比较当前、近期和先前使用他汀类药物与未使用者。
大多数他汀类药物使用者被归类为当前使用者（90%）。当前使用阿托伐他汀（OR = 0.88；95% = CI 0.82，0.96）、辛伐他汀（OR = 0.84；95% CI = 0.79，0.91）和瑞舒伐他汀（OR = 0.79；95% CI = 0.67，0.94）与创伤性脑损伤后住院死亡风险显著降低相关。
除了是最常用的他汀类药物外，当前使用阿托伐他汀、瑞舒伐他汀和辛伐他汀与老年人群创伤性脑损伤后住院死亡率显著降低相关。未来的研究必须包括临床试验，以帮助排除健康使用者效应的可能性，以便更好地了解他汀类药物使用对创伤性脑损伤后住院死亡率的影响。
