Statins and the Risk of Herpes Zoster: A Population-Based Cohort Study
Background. Statins are widely used lipid-lowering drugs with immunomodulatory properties that may favor reactivation of latent varicella-zoster virus infection. However, whether statins increase the risk of herpes zoster is unknown. Methods. We conducted a population-based retrospective cohort stud...
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| Published in | Clinical infectious diseases Vol. 58; no. 3; pp. 350 - 356 |
|---|---|
| Main Authors | , , , , , |
| Format | Journal Article |
| Language | English |
| Published |
Oxford
OXFORD UNIVERSITY PRESS
01.02.2014
Oxford University Press |
| Subjects | |
| Online Access | Get full text |
| ISSN | 1058-4838 1537-6591 1537-6591 |
| DOI | 10.1093/cid/cit745 |
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| Abstract | Background. Statins are widely used lipid-lowering drugs with immunomodulatory properties that may favor reactivation of latent varicella-zoster virus infection. However, whether statins increase the risk of herpes zoster is unknown. Methods. We conducted a population-based retrospective cohort study of Ontario residents aged ≥66 years between 1 April 1997 and 31 March 2010 to examine the association between statin use and incidence of herpes zoster. We used propensity score matching to ensure similarity between users and nonusers of statins, and Cox proportional hazard models to assess differences in outcomes between study groups. To test the specificity of our findings, we examined the association between statin exposure and knee arthroplasty. Results. During the 13-year study period, we matched 494 651 individuals treated with a statin to an equal number of untreated individuals. In the main analysis, the rate of herpes zoster was higher among users of statins relative to non-users of these drugs (13.25 vs 11.71 per 1000 person-years, respectively; hazard ratio [HR], 1.13; 95% confidence interval [CI], 1.10–1.17). The attributable fraction of exposed individuals was 11.6%. In a prespecified analysis, we found a similar risk of herpes zoster among statin users in the subgroup of patients with diabetes (HR, 1.18; 95% CI, 1.09–1.27). As expected, we found no association between statin use and knee arthroplasty (HR, 1.04; 95% CI, .99–1.09). Conclusions. Among older patients, treatment with statins is associated with a small but significantly increased risk of herpes zoster. |
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| AbstractList | Statins have immunomodulating properties that may increase the risk of varicella-zoster virus reactivation. We found that older patients treated with statins were at an increased risk of developing herpes zoster relative to individuals who were not prescribed to these drugs.
Background.
Statins are widely used lipid-lowering drugs with immunomodulatory properties that may favor reactivation of latent varicella-zoster virus infection. However, whether statins increase the risk of herpes zoster is unknown.
Methods.
We conducted a population-based retrospective cohort study of Ontario residents aged ≥66 years between 1 April 1997 and 31 March 2010 to examine the association between statin use and incidence of herpes zoster. We used propensity score matching to ensure similarity between users and nonusers of statins, and Cox proportional hazard models to assess differences in outcomes between study groups. To test the specificity of our findings, we examined the association between statin exposure and knee arthroplasty.
Results.
During the 13-year study period, we matched 494 651 individuals treated with a statin to an equal number of untreated individuals. In the main analysis, the rate of herpes zoster was higher among users of statins relative to nonusers of these drugs (13.25 vs 11.71 per 1000 person-years, respectively; hazard ratio [HR], 1.13; 95% confidence interval [CI], 1.10–1.17). The attributable fraction of exposed individuals was 11.6%. In a prespecified analysis, we found a similar risk of herpes zoster among statin users in the subgroup of patients with diabetes (HR, 1.18; 95% CI, 1.09–1.27). As expected, we found no association between statin use and knee arthroplasty (HR, 1.04; 95% CI, .99–1.09).
Conclusions.
Among older patients, treatment with statins is associated with a small but significantly increased risk of herpes zoster. Statins are widely used lipid-lowering drugs with immunomodulatory properties that may favor reactivation of latent varicella-zoster virus infection. However, whether statins increase the risk of herpes zoster is unknown. We conducted a population-based retrospective cohort study of Ontario residents aged ≥ 66 years between 1 April 1997 and 31 March 2010 to examine the association between statin use and incidence of herpes zoster. We used propensity score matching to ensure similarity between users and nonusers of statins, and Cox proportional hazard models to assess differences in outcomes between study groups. To test the specificity of our findings, we examined the association between statin exposure and knee arthroplasty. During the 13-year study period, we matched 494 651 individuals treated with a statin to an equal number of untreated individuals. In the main analysis, the rate of herpes zoster was higher among users of statins relative to nonusers of these drugs (13.25 vs 11.71 per 1000 person-years, respectively; hazard ratio [HR], 1.13; 95% confidence interval [CI], 1.10-1.17). The attributable fraction of exposed individuals was 11.6%. In a prespecified analysis, we found a similar risk of herpes zoster among statin users in the subgroup of patients with diabetes (HR, 1.18; 95% CI, 1.09-1.27). As expected, we found no association between statin use and knee arthroplasty (HR, 1.04; 95% CI, .99-1.09). Among older patients, treatment with statins is associated with a small but significantly increased risk of herpes zoster. Statins are widely used lipid-lowering drugs with immunomodulatory properties that may favor reactivation of latent varicella-zoster virus infection. However, whether statins increase the risk of herpes zoster is unknown. We conducted a population-based retrospective cohort study of Ontario residents aged ≥66 years between 1 April 1997 and 31 March 2010 to examine the association between statin use and incidence of herpes zoster. We used propensity score matching to ensure similarity between users and nonusers of statins, and Cox proportional hazard models to assess differences in outcomes between study groups. To test the specificity of our findings, we examined the association between statin exposure and knee arthroplasty. During the 13-year study period, we matched 494 651 individuals treated with a statin to an equal number of untreated individuals. In the main analysis, the rate of herpes zoster was higher among users of statins relative to nonusers of these drugs (13.25 vs 11.71 per 1000 person-years, respectively; hazard ratio [HR], 1.13; 95% confidence interval [CI], 1.10-1.17). The attributable fraction of exposed individuals was 11.6%. In a prespecified analysis, we found a similar risk of herpes zoster among statin users in the subgroup of patients with diabetes (HR, 1.18; 95% CI, 1.09-1.27). As expected, we found no association between statin use and knee arthroplasty (HR, 1.04; 95% CI, .99-1.09). Among older patients, treatment with statins is associated with a small but significantly increased risk of herpes zoster. Statins are widely used lipid-lowering drugs with immunomodulatory properties that may favor reactivation of latent varicella-zoster virus infection. However, whether statins increase the risk of herpes zoster is unknown.BACKGROUNDStatins are widely used lipid-lowering drugs with immunomodulatory properties that may favor reactivation of latent varicella-zoster virus infection. However, whether statins increase the risk of herpes zoster is unknown.We conducted a population-based retrospective cohort study of Ontario residents aged ≥ 66 years between 1 April 1997 and 31 March 2010 to examine the association between statin use and incidence of herpes zoster. We used propensity score matching to ensure similarity between users and nonusers of statins, and Cox proportional hazard models to assess differences in outcomes between study groups. To test the specificity of our findings, we examined the association between statin exposure and knee arthroplasty.METHODSWe conducted a population-based retrospective cohort study of Ontario residents aged ≥ 66 years between 1 April 1997 and 31 March 2010 to examine the association between statin use and incidence of herpes zoster. We used propensity score matching to ensure similarity between users and nonusers of statins, and Cox proportional hazard models to assess differences in outcomes between study groups. To test the specificity of our findings, we examined the association between statin exposure and knee arthroplasty.During the 13-year study period, we matched 494 651 individuals treated with a statin to an equal number of untreated individuals. In the main analysis, the rate of herpes zoster was higher among users of statins relative to nonusers of these drugs (13.25 vs 11.71 per 1000 person-years, respectively; hazard ratio [HR], 1.13; 95% confidence interval [CI], 1.10-1.17). The attributable fraction of exposed individuals was 11.6%. In a prespecified analysis, we found a similar risk of herpes zoster among statin users in the subgroup of patients with diabetes (HR, 1.18; 95% CI, 1.09-1.27). As expected, we found no association between statin use and knee arthroplasty (HR, 1.04; 95% CI, .99-1.09).RESULTSDuring the 13-year study period, we matched 494 651 individuals treated with a statin to an equal number of untreated individuals. In the main analysis, the rate of herpes zoster was higher among users of statins relative to nonusers of these drugs (13.25 vs 11.71 per 1000 person-years, respectively; hazard ratio [HR], 1.13; 95% confidence interval [CI], 1.10-1.17). The attributable fraction of exposed individuals was 11.6%. In a prespecified analysis, we found a similar risk of herpes zoster among statin users in the subgroup of patients with diabetes (HR, 1.18; 95% CI, 1.09-1.27). As expected, we found no association between statin use and knee arthroplasty (HR, 1.04; 95% CI, .99-1.09).Among older patients, treatment with statins is associated with a small but significantly increased risk of herpes zoster.CONCLUSIONSAmong older patients, treatment with statins is associated with a small but significantly increased risk of herpes zoster. Background. Statins are widely used lipid-lowering drugs with immunomodulatory properties that may favor reactivation of latent varicella-zoster virus infection. However, whether statins increase the risk of herpes zoster is unknown. Methods. We conducted a population-based retrospective cohort study of Ontario residents aged ≥66 years between 1 April 1997 and 31 March 2010 to examine the association between statin use and incidence of herpes zoster. We used propensity score matching to ensure similarity between users and nonusers of statins, and Cox proportional hazard models to assess differences in outcomes between study groups. To test the specificity of our findings, we examined the association between statin exposure and knee arthroplasty. Results. During the 13-year study period, we matched 494 651 individuals treated with a statin to an equal number of untreated individuals. In the main analysis, the rate of herpes zoster was higher among users of statins relative to non-users of these drugs (13.25 vs 11.71 per 1000 person-years, respectively; hazard ratio [HR], 1.13; 95% confidence interval [CI], 1.10–1.17). The attributable fraction of exposed individuals was 11.6%. In a prespecified analysis, we found a similar risk of herpes zoster among statin users in the subgroup of patients with diabetes (HR, 1.18; 95% CI, 1.09–1.27). As expected, we found no association between statin use and knee arthroplasty (HR, 1.04; 95% CI, .99–1.09). Conclusions. Among older patients, treatment with statins is associated with a small but significantly increased risk of herpes zoster. |
| Author | Mamdani, Muhammad M. Juurlink, David N. Antoniou, Tony Zheng, Hong Singh, Samantha Gomes, Tara |
| AuthorAffiliation | 3 University of Toronto 6 Applied Health Research Centre, St Michael's Hospital , Toronto, Ontario, Canada 5 Sunnybrook Research Institute 7 King Saud University , Riyadh , Saudi Arabia 1 Department of Family and Community Medicine , St Michael's Hospital 2 Keenan Research Centre of the Li Ka Shing Knowledge Institute, St Michael's Hospital 4 Institute for Clinical Evaluative Sciences |
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| Author_xml | – sequence: 1 givenname: Tony surname: Antoniou fullname: Antoniou, Tony – sequence: 2 givenname: Hong surname: Zheng fullname: Zheng, Hong – sequence: 3 givenname: Samantha surname: Singh fullname: Singh, Samantha – sequence: 4 givenname: David N. surname: Juurlink fullname: Juurlink, David N. – sequence: 5 givenname: Muhammad M. surname: Mamdani fullname: Mamdani, Muhammad M. – sequence: 6 givenname: Tara surname: Gomes fullname: Gomes, Tara |
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| Copyright | Copyright © 2014 Oxford University Press on behalf of the Infectious Diseases Society of America The Author 2013. Published by Oxford University Press on behalf of the Infectious Diseases Society of America. 2013 2015 INIST-CNRS Copyright Oxford University Press, UK Feb 1, 2014 |
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| Keywords | herpes zoster statins elderly population-based drug safety Infection Skin disease Nervous system diseases Herpes zoster Viral disease Cohort study Risk factor Statin derivative Antilipemic agent |
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| Snippet | Background. Statins are widely used lipid-lowering drugs with immunomodulatory properties that may favor reactivation of latent varicella-zoster virus... Statins have immunomodulating properties that may increase the risk of varicella-zoster virus reactivation. We found that older patients treated with statins... Statins are widely used lipid-lowering drugs with immunomodulatory properties that may favor reactivation of latent varicella-zoster virus infection. However,... |
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| SubjectTerms | Aged Aged, 80 and over and Commentaries Anticholesteremic Agents - adverse effects Anticholesteremic Agents - therapeutic use Arthroplasty ARTICLES AND COMMENTARIES Biological and medical sciences Cohort Studies Diabetes Dosage Drug prescriptions Female Health outcomes Herpes viruses Herpes zoster Herpes Zoster - epidemiology Herpes zoster vaccines Human herpesvirus 3 Human viral diseases Humans Immunologic Factors - adverse effects Immunologic Factors - therapeutic use Infectious diseases Joint surgery Lipids Male Medical sciences Ontario - epidemiology Prescription drugs Retrospective Studies Risk Assessment Statins Viral diseases Viral diseases with cutaneous or mucosal lesions and viral diseases of the eye |
| Title | Statins and the Risk of Herpes Zoster: A Population-Based Cohort Study |
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