Statin therapy and mortality in HIV-infected individuals; a Danish nationwide population-based cohort study.

<h4>Background</h4>Recent studies have suggested that statins possess diverse immune modulatory and anti-inflammatory properties. As statins might attenuate inflammation, statin therapy has been hypothesized to reduce mortality in HIV-infected individuals. We therefore used a Danish nati...

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Autores principales:	Line D Rasmussen, Gitte Kronborg, Carsten S Larsen, Court Pedersen, Jan Gerstoft, Niels Obel
Formato:	article
Lenguaje:	EN
Publicado:	Public Library of Science (PLoS) 2013
Materias:	Medicine R Science Q
Acceso en línea:	https://doaj.org/article/9c9b54a05e3a4b518043727f8275881a
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spelling	oai:doaj.org-article:9c9b54a05e3a4b518043727f8275881a2021-11-18T07:55:10ZStatin therapy and mortality in HIV-infected individuals; a Danish nationwide population-based cohort study.1932-620310.1371/journal.pone.0052828https://doaj.org/article/9c9b54a05e3a4b518043727f8275881a2013-01-01T00:00:00Zhttps://www.ncbi.nlm.nih.gov/pmc/articles/pmid/23469159/?tool=EBIhttps://doaj.org/toc/1932-6203<h4>Background</h4>Recent studies have suggested that statins possess diverse immune modulatory and anti-inflammatory properties. As statins might attenuate inflammation, statin therapy has been hypothesized to reduce mortality in HIV-infected individuals. We therefore used a Danish nationwide cohort of HIV-infected individuals to estimate the impact of statin use on mortality before and after a diagnosis of cardiovascular disease, chronic kidney disease or diabetes.<h4>Methods</h4>We identified all Danish HIV-infected individuals (1,738) who initiated HAART after 1 January 1998, and achieved virological suppression within 180 days. Date of first redemption of a prescription of statin was obtained from the Danish National Prescription Registry. We used Poisson regression analysis to assess adjusted mortality rate ratios (aMRR). First, time was censored at date of virological failure (VL >500 copies/ml). Second, time was not censored at virological failure. All analyses were adjusted for potential confounders.<h4>Results</h4>In the analyses confined to observation time without virological failure (+ censoring) statin therapy was associated with a non-statistically significant reduced rate of death (aMRR 0.75; 95% CI: 0.33-1.68). No difference was observed in the analysis with no censoring (aMRR 1.17; 95% CI: 0.66-2.07). Use of statin seemed to reduce mortality in individuals after a diagnosis of comorbidity {(+ censoring: aMRR: 0.34; 95% CI: 0.11-1.04), (-censoring: aMRR: 0.64; 95% CI: 0.32-1.29)}. No difference in rate of death could be detected before first date of diagnosis of comorbidity {(+ censoring: aMRR: 1.12; 95% CI: 0.34-3.62), (-censoring: aMRR: 0.90; 95% CI: 0.28-2.88)}.<h4>Conclusion</h4>Statin therapy might reduce all-cause mortality in HIV-infected individuals, but the impact on individuals with no comorbidity seems small or absent. An unambiguous proof of a causal relation can only be obtained in a randomized controlled trial, but the sample size predicted may be prohibitive for its conduct.Line D RasmussenGitte KronborgCarsten S LarsenCourt PedersenJan GerstoftNiels ObelPublic Library of Science (PLoS)articleMedicineRScienceQENPLoS ONE, Vol 8, Iss 3, p e52828 (2013)
institution	DOAJ
collection	DOAJ
language	EN
topic	Medicine R Science Q
spellingShingle	Medicine R Science Q Line D Rasmussen Gitte Kronborg Carsten S Larsen Court Pedersen Jan Gerstoft Niels Obel Statin therapy and mortality in HIV-infected individuals; a Danish nationwide population-based cohort study.
description	<h4>Background</h4>Recent studies have suggested that statins possess diverse immune modulatory and anti-inflammatory properties. As statins might attenuate inflammation, statin therapy has been hypothesized to reduce mortality in HIV-infected individuals. We therefore used a Danish nationwide cohort of HIV-infected individuals to estimate the impact of statin use on mortality before and after a diagnosis of cardiovascular disease, chronic kidney disease or diabetes.<h4>Methods</h4>We identified all Danish HIV-infected individuals (1,738) who initiated HAART after 1 January 1998, and achieved virological suppression within 180 days. Date of first redemption of a prescription of statin was obtained from the Danish National Prescription Registry. We used Poisson regression analysis to assess adjusted mortality rate ratios (aMRR). First, time was censored at date of virological failure (VL >500 copies/ml). Second, time was not censored at virological failure. All analyses were adjusted for potential confounders.<h4>Results</h4>In the analyses confined to observation time without virological failure (+ censoring) statin therapy was associated with a non-statistically significant reduced rate of death (aMRR 0.75; 95% CI: 0.33-1.68). No difference was observed in the analysis with no censoring (aMRR 1.17; 95% CI: 0.66-2.07). Use of statin seemed to reduce mortality in individuals after a diagnosis of comorbidity {(+ censoring: aMRR: 0.34; 95% CI: 0.11-1.04), (-censoring: aMRR: 0.64; 95% CI: 0.32-1.29)}. No difference in rate of death could be detected before first date of diagnosis of comorbidity {(+ censoring: aMRR: 1.12; 95% CI: 0.34-3.62), (-censoring: aMRR: 0.90; 95% CI: 0.28-2.88)}.<h4>Conclusion</h4>Statin therapy might reduce all-cause mortality in HIV-infected individuals, but the impact on individuals with no comorbidity seems small or absent. An unambiguous proof of a causal relation can only be obtained in a randomized controlled trial, but the sample size predicted may be prohibitive for its conduct.
format	article
author	Line D Rasmussen Gitte Kronborg Carsten S Larsen Court Pedersen Jan Gerstoft Niels Obel
author_facet	Line D Rasmussen Gitte Kronborg Carsten S Larsen Court Pedersen Jan Gerstoft Niels Obel
author_sort	Line D Rasmussen
title	Statin therapy and mortality in HIV-infected individuals; a Danish nationwide population-based cohort study.
title_short	Statin therapy and mortality in HIV-infected individuals; a Danish nationwide population-based cohort study.
title_full	Statin therapy and mortality in HIV-infected individuals; a Danish nationwide population-based cohort study.
title_fullStr	Statin therapy and mortality in HIV-infected individuals; a Danish nationwide population-based cohort study.
title_full_unstemmed	Statin therapy and mortality in HIV-infected individuals; a Danish nationwide population-based cohort study.
title_sort	statin therapy and mortality in hiv-infected individuals; a danish nationwide population-based cohort study.
publisher	Public Library of Science (PLoS)
publishDate	2013
url	https://doaj.org/article/9c9b54a05e3a4b518043727f8275881a
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Statin therapy and mortality in HIV-infected individuals; a Danish nationwide population-based cohort study.

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