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Original Research |

Statin Use is Associated with a Lower Risk of Tuberculosis

Vincent Yi-Fong Su, MD; Wei-Juin Su, MSc; Yung-Feng Yen, MD, MPH, PhD; Sheng-Wei Pan, MD; Pei-Hung Chuang, PhD; Jia-Yih Feng, MD; Kun-Ta Chou, MD; Kuang-Yao Yang, MD, PhD; Yu-Chin Lee, MD; Tzeng-Ji Chen, MD, PhD
Author and Funding Information

Author Contributions: V-Y Su, and W-J Su had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.

Study concept and design: V-Y Su, W-J Su, Y-F Yen, S-W Pan, P-H Chuang, J-Y Feng, K-T Chou, K-Y Yang.

Acquisition of data: V-Y Su, W-J Su, Y-F Yen, S-W Pan, P-H Chuang.

Analysis and interpretation of data: V-Y Su, W-J Su, Y-F Yen, P-H Chuang

Drafting of the manuscript: V-Y Su, W-J Su, Y-F Yen, S-W Pan, P-H Chuang, J-Y Feng, K-T Chou, K-Y Yang.

Statistical analysis: V-Y Su, Y-F Yen, P-H Chuang.

Study supervision: J-Y Feng, K-T Chou, K-Y Yang, Y-C Lee, T-J Chen

1Department of Chest Medicine

2Center for prevention and treatment of occupational injury and disease

3Department of Family Medicine, Taipei Veterans General Hospital, Taipei, Taiwan

4Section of Infectious Diseases

5Department of Internal Medicine, Taipei City Hospital, Taipei, Taiwan

6Institute of Clinical Medicine

7Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan

8Sijhih Cathay General Hospital, New Taipei City, Taiwan

Corresponding author: Wei-Juin Su, MSc, Department of Chest Medicine, Taipei Veterans General Hospital No. 201, Sec. 2, Shih-Pai Road, Taipei 112, Taiwan.


Copyright 2017, . All Rights Reserved.


Chest. 2017. doi:10.1016/j.chest.2017.04.170
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Abstract

Background  Statins are widely used to lower cholesterol levels and cardiovascular risk. Further, studies have shown that statins may decrease the risks of infectious diseases and infection-related mortality. However, the association between statin use and active tuberculosis (TB) disease remains unclear.

Methods  Using the Taiwan National Health Insurance Research Database, we conducted a nationwide population-based study. Patients taking statins during 2000–2013, without antecedent TB disease, were included. Data from 102,424 statin users and 202,718 age-, sex-, and enrollment date-matched subjects were analyzed. The two cohorts were monitored until December 31, 2013 for incident TB disease. The definition of TB disease was validated using the claims database of Taipei Veterans General Hospital.

Results  The statin and matched cohorts were observed for 571,568 and 1,027,385 person-years, respectively. Of the total 305,142 subjects, 1,264 (0.41%) developed subsequent TB disease. Validation study confirmed the accuracy of the definition of TB disease (sensitivity, 96.3%), with excellent interobserver agreement (κ=1.00). Multivariate analysis revealed a reduced risk of TB disease among the statin cohort (hazard ratio [HR] 0.53, 95% confidence interval [CI] 0.47-0.61; p<0.001). Compared with the matched group, statin use showed a dose-response relationship with the incident TB disease risk (<180 cumulative defined daily doses [cDDDs]: HR 1.06, 95% CI 0.91-1.24, p=0.477; 180-365 cDDDs: HR 0.57, 95% CI 0.45-0.72, p<0.001; >365 cDDDs: HR 0.27, 95% CI 0.22-0.33, p<0.001).

Conclusions  Statin use associates with a lower risk of incident TB disease.


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