长期护理机构居民使用他汀类药物与跌倒相关的住院情况：病例对照研究。
Statin use and fall-related hospitalizations among residents of long-term care facilities: A case-control study.
机构信息
Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, Victoria, Australia; Pharmacy Department, Alfred Health, Melbourne, Victoria, Australia; School of Health & Biomedical Sciences, RMIT University, Bundoora, Victoria, Australia.
Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, Victoria, Australia; NHMRC Cognitive Decline Partnership Centre, Hornsby Ku-ring-gai Hospital, Hornsby, New South Wales, Australia; Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia; School of Pharmacy and Medical Sciences, University of South Australia, Adelaide, South Australia, Australia.
出版信息
J Clin Lipidol. 2020 Jul-Aug;14(4):507-514. doi: 10.1016/j.jacl.2020.05.008. Epub 2020 May 22.
BACKGROUND
Statins are associated with muscle-related adverse events, but few studies have investigated the association with fall-related hospitalizations among residents of long-term care facilities (LTCFs).
OBJECTIVE
The objective of the study is to investigate whether statin use is associated with fall-related hospitalizations from LTCFs.
METHODS
A case-control study was conducted among residents aged ≥65 years admitted to hospital from 2013 to 2015. Cases (n = 332) were residents admitted for falls and fall-related injuries. Controls (n = 332) were selected from patients admitted for reasons other than cardiovascular and diabetes. Cases and controls were matched 1:1 by age (±2 years), index date of admission (±6 months), and sex. Adjusted odds ratios (aORs) and 95% confidence intervals (CIs) were estimated using conditional logistic regression, after considering for history of falls, hypertension, dementia, functional comorbidity index, polypharmacy (≥9 regular preadmission medications), and fall-risk medications. Subanalyses were performed for individual statins, dementia, and statin intensity.
RESULTS
Overall, 43.1% of cases and 27.1% of controls used statins. Statins were associated with fall-related hospitalizations (aOR = 2.24, 95% CI 1.56-3.23), in particular simvastatin (aOR = 2.26, 95% CI 1.22-4.20) and atorvastatin (aOR = 2.08, 95% CI 1.33-3.24). Statins were associated with fall-related hospitalizations in residents with (aOR = 2.34, 95% CI 1.33-4.11) and without dementia (aOR = 2.30, 95% CI 1.46-3.63). There was no association between statin intensity and fall-related hospitalizations (aOR = 0.78, 95% CI 0.43-1.40).
CONCLUSION
This study suggests a possible association between statin use and fall-related hospitalizations among residents living in LTCFs. However, there was minimal evidence for a relationship between statin intensity and fall-related hospitalizations. Further research is required to substantiate these hypothesis-generating findings.
背景
他汀类药物与肌肉相关的不良反应有关，但很少有研究调查其与长期护理机构（LTCF）中与跌倒相关的住院之间的关系。
目的
本研究旨在探讨他汀类药物的使用是否与 LTCF 中的跌倒相关住院有关。
方法
对 2013 年至 2015 年期间因跌倒和跌倒相关损伤住院的≥65 岁居民进行了病例对照研究。病例（n=332）为因跌倒和跌倒相关损伤而住院的居民。对照组（n=332）为因心血管疾病和糖尿病以外的原因入院的患者。病例和对照组按年龄（±2 岁）、入院日期（±6 个月）和性别进行 1:1 匹配。使用条件逻辑回归考虑跌倒史、高血压、痴呆、功能合并症指数、多药治疗（≥9 种常规入院前药物）和跌倒风险药物后，估计调整后的优势比（aOR）和 95%置信区间（CI）。对个别他汀类药物、痴呆和他汀类药物强度进行了亚分析。
结果
总体而言，43.1%的病例和 27.1%的对照组使用了他汀类药物。他汀类药物与跌倒相关住院有关（aOR=2.24，95%CI 1.56-3.23），特别是辛伐他汀（aOR=2.26，95%CI 1.22-4.20）和阿托伐他汀（aOR=2.08，95%CI 1.33-3.24）。在有（aOR=2.34，95%CI 1.33-4.11）和没有痴呆（aOR=2.30，95%CI 1.46-3.63）的居民中，他汀类药物与跌倒相关住院有关。他汀类药物强度与跌倒相关住院无相关性（aOR=0.78，95%CI 0.43-1.40）。
结论
本研究表明，他汀类药物的使用与 LTCF 居民的跌倒相关住院之间可能存在关联。然而，他汀类药物强度与跌倒相关住院之间的关系几乎没有证据。需要进一步的研究来证实这些产生假说的发现。
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