Department of Clinical Pharmacy and Outcomes Sciences, University of South Carolina College of Pharmacy, 715 Sumter Street, Columbia, SC, 29208, USA.
Dorn Research Institute, WJB Dorn Veterans Affairs Medical Center, Columbia, SC, USA.
Am J Cardiovasc Drugs. 2021 Jan;21(1):103-112. doi: 10.1007/s40256-020-00404-2.
We sought to evaluate the relationship between acute liver injury (ALI) and statins utilizing the Veterans Affairs Informatics and Computing Infrastructure (VINCI) database.
This retrospective cohort study, spanning January 2000-December 2018, compared ALI (aminotransferase > 200 U/L, severe ALI, and hospitalization with ALI) in statin users and non-users among uninfected, hepatitis C virus (HCV) mono-infected, human immunodeficiency virus (HIV)/HCV co-infected, and HIV mono-infected veterans within 18 months. We estimated adjusted Cox proportional hazards models comparing statin users and non-users and comparing statin intensity level with non-use; and estimate Cox proportional hazards models utilizing time-dependent coding of statin intensity. Adjusted models included restricted cubic splines of the propensity score as an adjustment variable.
From a total of 166,439 patients who met the study criteria, statin initiators were older, had higher values of body mass index, higher values of low-density lipoprotein cholesterol and triglycerides, and lower values of high-density lipoprotein cholesterol. HCV mono-infected and HIV/HCV co-infected cohorts had the highest rates of ALI, and statin users had lower rates across all outcomes of ALI compared with non-users in unadjusted analysis. Statin use is associated with a lower risk of all ALI outcomes compared with non-users. Patients on a high intensity are not associated with a statistically significant increase in risk for any ALI outcome. For each additional 30 days of treatment, there was a reduced risk of any ALI outcome across all cohorts.
Statin initiators had a lower risk of any ALI outcome compared with non-users within 18 months regardless of HIV and/or HCV status.
利用退伍军人事务部信息学和计算基础设施（VINCI）数据库，评估急性肝损伤（ALI）与他汀类药物之间的关系。
这是一项回顾性队列研究，时间跨度为 2000 年 1 月至 2018 年 12 月，比较了未感染、丙型肝炎病毒（HCV）单感染、人类免疫缺陷病毒（HIV）/HCV 共感染和 HIV 单感染退伍军人在 18 个月内他汀类药物使用者和非使用者之间的 ALI（转氨酶>200 U/L、严重 ALI 和因 ALI 住院）。我们使用调整后的 Cox 比例风险模型比较了他汀类药物使用者和非使用者，并比较了他汀类药物强度水平与非使用者；并利用他汀类药物强度的时间依赖性编码来估计 Cox 比例风险模型。调整后的模型包括倾向评分的限制三次样条作为调整变量。
在符合研究标准的 166439 名患者中，他汀类药物的使用者年龄较大，体重指数、低密度脂蛋白胆固醇和甘油三酯值较高，高密度脂蛋白胆固醇值较低。HCV 单感染和 HIV/HCV 共感染队列的 ALI 发生率最高，与未使用者相比，所有 ALI 结局的发生率均较低。与未使用者相比，他汀类药物使用者与所有 ALI 结局的风险降低相关。高强度治疗的患者与任何 ALI 结局的风险增加均无统计学意义。在所有队列中，每增加 30 天的治疗，任何 ALI 结局的风险都会降低。
与未使用者相比，他汀类药物使用者在 18 个月内发生任何 ALI 结局的风险均降低，无论 HIV 和/或 HCV 状态如何。
