Abstract P344: Statin Therapy Does not Increase the Risk for a Medically-Treated Fall

Background: It has been suggested that taking statins may increase the risk of a fall due to myopathy. However, studies have reported contradictory evidence regarding the association between statin use and fall risk. The purpose of this study was to determine whether taking statins increases the risk of falls in patients undergoing a coronary angiography. Methods: The study population was a subset subjects from the Intermountain Heart Collaborative Study (n=1011). A subject was considered as taking statins if they were discharged with statins and had record of a filled statin prescription (n=810); they were considered as not taking statins if they had no prior statin use, were not discharged with statins, and had no record of a filled statin prescription (n=203). Electronic medical records were queried to determined medically treated falls (ICD-9: E8850-E8869; E888x) within 5 years of their angiography. Univariate association testing between falls and cardiovascular medications, co-morbidities, and demographic factors were done. Multivariate Cox regression analysis was used to test the association between statin use and fall risk while adjusting for the other factors found to be associated with fall risk in the univariate analyses. Results: Of the 1011 subjects, 112 (11%) had at least one medically-treated fall within 5 years. In the univariate analyses, statin use (p=0.024), age (p<0.001), sex (p=0.001), hypertension (p=0.040), diabetes (p<0.001), history of atrial fibrillation (AF) (p<0.001), and coumadin use (p=0.009) were associated with falls. Even after adjustment by other risk factors, statin use was associated with a decrease risk of a fall (HR=0.62; 0.40, 0.94). The factors conferring the most risk of a fall were diabetes, AF, and age (Table 1). Conclusions: Statin use was associated with a 1.6-fold decreased risk for a medically-treated fall. This suggests that clinicians may not need to caution patients taking statins regarding an increase risk of falls.

Download Full-text

Preadmission Statin Use and 90-day Mortality in the Critically Ill

Anesthesiology ◽

10.1097/aln.0000000000002811 ◽

2019 ◽

Vol 131 (2) ◽

pp. 315-327 ◽

Cited By ~ 1

Author(s):

Tak Kyu Oh ◽

In-Ae Song ◽

Jae Ho Lee ◽

Cheong Lim ◽

Young-Tae Jeon ◽

...

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Mortality Rate ◽

Critically Ill ◽

Cox Regression ◽

Hazard Ratio ◽

Cox Regression Analysis ◽

Statin Dose ◽

Mortality Hazard Ratio ◽

Statin Use

Abstract Editor’s Perspective What We Already Know about This Topic What This Article Tells Us That Is New Background This study aimed to examine the association between preadmission statin use and 90-day mortality in critically ill patients and to investigate whether this association differed according to statin type and dose. We hypothesized that preadmission statin use was associated with lower 90-day mortality. Methods This retrospective cohort study analyzed the medical records of all adult patients admitted to the intensive care unit in a single tertiary academic hospital between January 2012 and December 2017. Data including preadmission statin use, statin subtype, and daily dosage were collected, and the associations between these variables and 90-day mortality after intensive care unit admission were examined. The primary endpoint was 90-day mortality. Results A total of 24,928 patients (7,396 statin users and 17,532 non–statin users) were included. After propensity score matching, 5,354 statin users and 7,758 non–statin users were finally included. The 90-day mortality rate was significantly higher in non–statin users (918 of 7,758; 11.8%) than in statin users (455 of 5,354; 8.5%; P < 0.001). In Cox regression analysis, the 90-day mortality rate was lower among statin users than among non–statin users (hazard ratio: 0.70, 95% CI: 0.63 to 0.79; P < 0.001). Rosuvastatin use was associated with 42% lower 90-day mortality (hazard ratio: 0.58, 95% CI: 0.47 to 0.72; P < 0.001). There were no specific significant differences in the association between daily statin dose and 90-day mortality. In competing risk analysis, the risk of noncardiovascular 90-day mortality in statin users was 32% lower than that in non–statin users (hazard ratio: 0.68, 95% CI: 0.60 to 0.78; P < 0.001). Meanwhile, cardiovascular 90-day mortality was not significantly associated with statin use. Conclusions Preadmission statin use was associated with a lower 90-day mortality. This association was more evident in the rosuvastatin group and with noncardiovascular 90-day mortality; no differences were seen according to daily dosage intensity.

Download Full-text

Effect of statin and metformin on survival in veterans (V) with B-cell lymphoproliferative disorders (BLD).

Journal of Clinical Oncology ◽

10.1200/jco.2013.31.15_suppl.1602 ◽

2013 ◽

Vol 31 (15_suppl) ◽

pp. 1602-1602

Author(s):

Shanthi Srinivas ◽

Melanie L. Gonzalez ◽

Sunniya Khan ◽

Arpita Gandhi ◽

Barbara Crump ◽

...

Keyword(s):

Rating Scale ◽

Cox Regression ◽

Univariate Analysis ◽

Laboratory Data ◽

Cox Regression Analysis ◽

Comorbidity Index ◽

Beta 2 Microglobulin ◽

Ecog Ps ◽

The Impact ◽

Statin Use

1602 Background: The incidence of BLD has been increasing in V. As many V are on statin and metformin for comorbid conditions, we evaluated the impact of their use on survival. Methods: In an IRB-approved protocol, we reviewed the records of 332 V diagnosed with BLD from January 1997 to Dec 2011 for demographics, height(H),weight(W), BMI,statin and metformin use, clinical and laboratory data and ECOG PS. Comorbidity was assessed using the Charlson Comorbidity Index (CCI),Kaplan-Feinstein Index (KFI) and Cumulative Illness Rating Scale (CIRS). Cox regression analysis was performed using SAS v 9.2. Results: There were 332 V with a median (M) age of 70 years (27-94). The M for H 70 inches (58-78), W 183lbs (99-356.5) and BMI 26.7 kg/m2 (15.54 -48.45). The M for hemoglobin(Hgb) 12.8 g/dl (7.3-17.4), albumin 3.9(1.2-5.4), lactate dehydrogenase( LDH) 183 IU/L (85-1905), beta 2-microglobulin 2.6 mg/dl (0.8-39) . The M for CCI was 4.7 (0.8-12), KFI 2 (0-3), CIRS15 3 (0-6), CIRS16 6(0 -14), CIRS17 1.9(0-6), CIRS18 0(0-3), CIRS19 0(0-3). M survival was 1297days(4-7468).The number of V receiving statin was 167 (51%) and metformin 46 (14%). Statin use was a predictor of survival by both univariate and multivariate analysis but metformin was a predictor only by univariate analysis. Conclusions: Statin use was an independent and significant predictor of survival in this group of V with BLD and needs to be validated in a larger group of patients. [Table: see text]

Download Full-text

Factors Associated with Achievement of Inactive Disease in Children with Juvenile Idiopathic Arthritis Treated with Etanercept

The Journal of Rheumatology ◽

10.3899/jrheum.120842 ◽

2012 ◽

Vol 40 (2) ◽

pp. 192-200 ◽

Cited By ~ 36

Author(s):

NICOLETTA SOLARI ◽

ELENA PALMISANI ◽

ALESSANDRO CONSOLARO ◽

ANGELA PISTORIO ◽

STEFANIA VIOLA ◽

...

Keyword(s):

Regression Analysis ◽

Juvenile Idiopathic Arthritis ◽

Clinical Remission ◽

Clinical Characteristics ◽

Cox Regression ◽

Disease Onset ◽

Inactive Disease ◽

Cox Regression Analysis ◽

Factors Associated ◽

Univariate Analyses

Objective.To evaluate the rate of inactive disease in children with juvenile idiopathic arthritis (JIA) treated with etanercept, and to identify clinical characteristics associated with attainment of inactive disease.Methods.Clinical charts of patients who were given etanercept between January 2002 and January 2011 were evaluated retrospectively. For each patient, all visits from initiation of etanercept to the last followup evaluation in which the patient was still receiving etanercept were examined to establish whether the patient had reached the state of inactive disease and to identify the first visit in which inactive disease was documented. Clinical characteristics associated with achievement of inactive disease were determined through univariate analyses and Cox regression procedures.Results.A total of 173 patients who received etanercept for a median of 2.2 years (range 0.5–10.5 yrs) were studied. Eighty-seven patients (50.3%) achieved inactive disease after a median of 0.6 years (range 0.1–2.5 yrs) of therapy. At last followup evaluation, 85 patients (49.1%) still had inactive disease and 70 (40.5%) were in clinical remission on medication. The probability of achievement of inactive disease after 6, 12, and 24 months of therapy was 24%, 46% and 57%, respectively. On Cox regression analysis, the attainment of inactive disease was associated with lack of wrist involvement and an age at disease onset < 3.6 years.Conclusion.Around half of our patients with JIA treated with etanercept achieved a state of inactive disease. Children who lacked wrist involvement and were younger at disease onset had a greater likelihood of achieving inactive disease.

Download Full-text

Prediction of Balance Perturbations and Falls on Stairs in Older People Using a Biomechanical Profiling Approach: A 12-Month Longitudinal Study

The Journals of Gerontology Series A ◽

10.1093/gerona/glaa130 ◽

2020 ◽

Author(s):

Thijs Ackermans ◽

Natasha Francksen ◽

Carolyn Lees ◽

Fyllis Papatzika ◽

Adamantios Arampatzis ◽

...

Keyword(s):

Risk Factors ◽

Older Adults ◽

Older People ◽

Fall Risk ◽

Assessment Tool ◽

Cox Regression ◽

Screening Tools ◽

Major Health Problem ◽

Cox Regression Analysis ◽

Psychological Parameters

Abstract Background Stair falls are a major health problem for older people, but presently, there are no specific screening tools for stair fall prediction. The purpose of the present study was to investigate whether stair fallers could be differentiated from nonfallers by biomechanical risk factors or physical/psychological parameters and to establish the biomechanical stepping profile posing the greatest risk for a stair fall. Methods Eighty-seven older adults (age: 72.1 ± 5.2 years) negotiated an instrumented seven-step staircase and performed a range of physical/psychological tasks. k-Means clustering was used to profile the overall stair negotiation behavior with biomechanical parameters indicative of fall risk as input. Falls and events of balance perturbation (combined “hazardous events”) were then monitored during a 12-month follow-up. Cox-regression analysis was performed to examine whether physical/psychological parameters or biomechanical outcome measures could predict future hazardous events. Kaplan–Meier survival curves were obtained to identify the stepping strategy posing a risk for a hazardous event. Results Physical/psychological parameters did not predict hazardous events and the commonly used Fall Risk Assessment Tool classified only 1/17 stair fallers at risk for a fall. Single biomechanical risk factors could not predict hazardous events on stairs either. On the contrary, two particular clusters identified by the stepping profiling method in stair ascent were linked with hazardous events. Conclusion This highlights the potential of the stepping profiling method to predict stair fall risk in older adults against the limited predictability of single-parameter approaches currently used as screening tools.

Download Full-text

Statin treatment increases the clinical risk of tendinopathy through matrix metalloproteinase release – a cohort study design combined with an experimental study

Scientific Reports ◽

10.1038/s41598-019-53238-7 ◽

2019 ◽

Vol 9 (1) ◽

Author(s):

Pernilla Eliasson ◽

Franciele Dietrich-Zagonel ◽

Anna-Carin Lundin ◽

Per Aspenberg ◽

Alicja Wolk ◽

...

Keyword(s):

Matrix Metalloproteinase ◽

Cox Regression ◽

3D Cell Culture ◽

Statin Treatment ◽

Population Based ◽

Trigger Finger ◽

Cox Regression Analysis ◽

Cohort Study Design ◽

Statin Use

AbstractRecent experimental evidence indicates potential adverse effects of statin treatment on tendons but previous clinical studies are few and inconclusive. The aims of our study were, first, to determine whether statin use in a cohort design is associated with tendinopathy disorders, and second, to experimentally understand the pathogenesis of statin induced tendinopathy. We studied association between statin use and different tendon injuries in two population-based Swedish cohorts by time-dependent Cox regression analysis. Additionally, we tested simvastatin in a 3D cell culture model with human tenocytes. Compared with never-users, current users of statins had a higher incidence of trigger finger with adjusted hazard ratios (aHRs) of 1.50 for men (95% confidence interval [CI] 1.21–1.85) and 1.21 (1.02–1.43) for women. We also found a higher incidence of shoulder tendinopathy in both men (aHR 1.43; 1.24–1.65) and women (aHR 1.41; 0.97–2.05). Former users did not confer a higher risk of tendinopathies. In vitro experiments revealed an increased release of matrix metalloproteinase (MMP)-1 and MMP-13 and a weaker, disrupted matrix after simvastatin exposure. Current statin use seems to increase the risk of trigger finger and shoulder tendinopathy, possibly through increased MMP release, and subsequently, a weakened tendon matrix which will be more prone to injuries.

Download Full-text

Statin Use Decreases the Risk of Metachronous Gastric Cancer in Patients without Helicobacter pylori Infection

Cancers ◽

10.3390/cancers13051020 ◽

2021 ◽

Vol 13 (5) ◽

pp. 1020

Author(s):

Tae Jin Kwon ◽

Tae Jun Kim ◽

Hyuk Lee ◽

Yang Won Min ◽

Byung-Hoon Min ◽

...

Keyword(s):

Gastric Cancer ◽

Endoscopic Resection ◽

Cox Regression ◽

Defined Daily Dose ◽

Cox Regression Analysis ◽

Daily Dose ◽

Metachronous Gastric Cancer ◽

H Pylori ◽

Statin Use

Previous studies have shown that statins reduce the risk of gastric cancer; however, their role has not been adequately studied in patients without Helicobacterpylori infection. We aimed to investigate whether statins reduced the risk of metachronous gastric cancer (GC) in H. pylori-negative patients who underwent endoscopic resection for early gastric cancer (EGC). Retrospective data of 2153 patients recruited between January 2007 and December 2016, with no H. pylori infection at baseline, who underwent resection for EGC, were analyzed. Metachronous GC was defined as a newly developed GC at least 1 year after endoscopic resection. Patients who used statins for at least 28 days during the follow-up period were considered as statin users. During a median follow-up of 5 years (interquartile range, 3.5–6.2), metachronous GC developed in 165 (7.6%) patients. In the multivariate Cox regression analysis, statin use was an independent factor associated with GC recurrence (adjusted hazard ratio (HR), 0.46; 95% confidence interval (CI), 0.26–0.82). Moreover, the risk of GC reduced with increasing duration (<3 years: HR 0.40, 95% CI 0.14–1.13; ≥3 years: HR 0.21, 95% CI 0.05–0.90; p trend = 0.011) and the dose of statin (cumulative defined daily dose (cDDD) < 500: HR 0.45, 95% CI 0.16–1.28; cDDD ≥ 500: HR 0.19, 95% CI 0.04–0.80; p trend = 0.008) in the propensity score-matched cohort. Statin use was associated with a lower risk of GC recurrence in H. pylori-negative patients with resected EGC in a dose-response relationship.

Download Full-text

Investigating serum β-HCG as an independent prognostic factor in patients (pts) receiving chemotherapy (Ct) for transitional cell carcinoma (TCC) of the urothelial tract.

Journal of Clinical Oncology ◽

10.1200/jco.2013.31.15_suppl.4549 ◽

2013 ◽

Vol 31 (15_suppl) ◽

pp. 4549-4549

Author(s):

Simon J. Crabb ◽

Adam Sharp ◽

Julia Head ◽

Caroline Chau ◽

Matthew Wheater ◽

...

Keyword(s):

Prognostic Factor ◽

Cox Regression ◽

Transitional Cell ◽

Multivariable Analysis ◽

Independent Prognostic Factor ◽

Prognostic Variables ◽

Free Survival ◽

Cox Regression Analysis ◽

Β Hcg ◽

Univariate Analyses

4549 Background: Serum human chorionic gonadotrophin β subunit (β-HCG) has prognostic value in TCC but has not been investigated in pts receiving Ct for this disease. Furthermore prior studies lacked statistical power to test independence from other prognostic variables. Methods: A single institution retrospective clinical database was constructed of pts receiving Ct between 2005 and 2011 for cancer of the urothelial tract. Eligible pts had pure or a component of TCC. Prognostic variables were tested by univariate Kaplan Meier analyses. Statistically significant variables were then assessed by multivariate cox regression analysis. A prospectively defined β-HCG cut-point of < versus ≥ 2 iu/L, either prior to (β-HCGp), or on completion of (β-HCGc) Ct was used. Results: 235 pts were eligible (72% male, 55% ≤70 years, 83% bladder primary). Initial Ct was perioperative (CtPeri) in 46% (7% adjuvant, 39% neoadjuvant). 63% had first line palliative Ct for metastatic disease (CtMet). For CtPeri, ECOG performance status (PS), haemoglobin (Hb), CtPeri regimen and T stage were statistically significant prognostic factors in univariate analyses for overall survival (OS), as were β-HCGp (median OS (mOS) 8.50 v. 1.86 years, p<0.001) and β-HCGc (mOS 4.27 v. 0.66 years, p=0.003). β-HCGp and β-HCGc after CtPeri were also prognostic for relapse free survival and in multivariable analysis remained statistically significant as a prognostic factor for OS (β-HCGp: hazard ratio (HR) 3.13, p=0.001; β-HCGc: HR 4.26, p=0.007). In pts treated with CtMet, PS, alkaline phosphatase, prior CtPeri, visceral metastases, CtMet regimen and β-HCGc (mOS 1.70 v. 1.07 years, p=0.005) were prognostic in univariate analyses for OS. β-HCGc after CtMet was also prognostic for progression free survival and in multivariable analysis remained statistically significant as a prognostic factor for OS (HR 3.47, p<0.001). Conclusions: β-HCG, and specifically its post-Ct level, is an independent prognostic factor for TCC treated with Ct in both curative and palliative settings. Prospective evaluation is warranted for incorporation into treatment selection strategies.

Download Full-text

FRACTURE RISK IN INCIDENT PARKINSONIAN COHORT VERSUS CONTROLS

Journal of Neurology Neurosurgery & Psychiatry ◽

10.1136/jnnp-2015-312379.174 ◽

2015 ◽

Vol 86 (11) ◽

pp. e4.84-e4

Author(s):

Isobel Sleeman ◽

Zhu-Chung Che ◽

Carl Counsell

Keyword(s):

Cox Regression ◽

Lewy Bodies ◽

Female Gender ◽

Long Bone ◽

P Value ◽

Vascular Parkinsonism ◽

Cox Regression Analysis ◽

Kaplan Meier ◽

Risk Of Falls ◽

Study Database

BackgroundPostural instability and resultant fractures are common in parkinsonism but no studies have analysed fracture rates in prospective incident cohorts of parkinsonian patients and controls.MethodsData from the PINE study (326 incident parkinsonian patients, 261 age-gender matched controls) were used. The study database included prospectively collected data on falls and fractures from annual reviews supplemented by hospital and GP records. Major fractures were defined as skull, long bone or pelvis. Kaplan-Meier curves for time-to-first fracture from diagnosis were analysed by diagnostic groups. Multivariate Cox regression analysis was used to identify factors that independently predicted fractures.ResultsThe fracture rates in patients with PD, Parkinson's plus syndromes, dementia with Lewy Bodies and vascular parkinsonism were similar (log rank p value=0.89) and so these groups were combined. The percentage of frequent fallers among the patients (24.2%) was higher than the controls (1.3%). The incidence of any fractures and major fractures was about three times higher in patients (5.51 and 4.25 per 100 patient-years respectively) than in controls (1.96 and 1.42 respectively). Parkinsonism, female gender, frequent fallers and development of dementia were independent predictors of major fractures.ConclusionPatients with parkinsonism have a much higher risk of falls and fractures.

Download Full-text

The impact of opioid medications on subsequent fractures in discharged emergency department patients with peripheral vertigo

CJEM ◽

10.1017/cem.2017.37 ◽

2017 ◽

Vol 20 (1) ◽

pp. 28-35 ◽

Cited By ~ 4

Author(s):

Keerat Grewal ◽

Peter C. Austin ◽

Moira K. Kapral ◽

Hong Lu ◽

Clare L. Atzema

Keyword(s):

Emergency Department ◽

Cox Regression ◽

Opioid Analgesic ◽

Administrative Databases ◽

Opioid Prescription ◽

Cox Regression Analysis ◽

Risk Of Falls ◽

Opioid Medications ◽

The Impact ◽

Peripheral Vertigo

AbstractBackgroundVertigo is common in the emergency department (ED). Most aetiologies are peripheral and do not require hospitalization, but many patients still fear falling. Some patients may be taking opioid analgesic medications (for other reasons); the risk of falls leading to fractures among patients with vertigo could be potentiated by the simultaneous use of opioids.ObjectivesTo examine the risk of fractures in discharged ED patients with peripheral vertigo who were being prescribed opioids during the same time period.MethodsLinked administrative databases from Ontario were used to compare discharged ED patients aged ≥65 with peripheral vertigo to patients with urinary tract infection (UTI) from 2006 to 2011. We used Cox regression analysis with an interaction term to estimate the modifying effect of an opioid prescription on the hazard of fracture within 90 days.ResultsThere were 13,012 patients with a peripheral vertigo syndrome and 76,885 with a UTI. Thirteen percent of the vertigo cohort and 25% of the UTI cohort had access to a filled opioid prescription. Compared to vertigo patients who did not fill an opioid prescription, the adjusted hazard of fracture among vertigo patients who did fill a prescription was 3.59 (95% CI 1.97–6.13). Among UTI patients who filled an opioid prescription the hazard ratio was 1.68 (95% CI 1.43–1.97) compared to UTI patients who did not.ConclusionsPatients discharged from the ED with peripheral vertigo who were also being prescribed opioids had a higher hazard of subsequent fracture compared to those who were not, and the effect was much greater than among UTI patients. These results suggest that in the acutely vertiginous older patient, opioid analgesic medications should be modified, where possible.

Download Full-text

Treatment of vertebral fractures due to osteoporosis

Osteologie/Osteology ◽

10.1055/s-0037-1622038 ◽

2015 ◽

Vol 24 (01) ◽

pp. 7-10 ◽

Cited By ~ 3

Author(s):

M. Pfeifer ◽

M. Sinaki

Keyword(s):

Exercise Program ◽

Therapeutic Exercise ◽

Training Support ◽

Axial Stability ◽

Extensor Muscles ◽

Therapeutic Exercises ◽

Increase Risk ◽

Risk Of Falls ◽

Risk Of Fall

SummaryThe objective of exercise in the treatment of osteoporosis is to improve axial stability through strengthening of back extensor muscles. Therefore, a back extension exercise program specific to one’s musculoskeletal competence and pain can be performed in a sitting position and later advanced to the prone position. When fragility is resolved, back extension is performed against resistance applied to the upper back. A significant reduction in back pain, kyphosis, and risk of falls and an improvement in the level of physical activity have been achieved through the SPEED (Spinal Proprioceptive Extension Exercise Dynamic) program. In addition, the application of a “Posture Training Support” (PTS) using a backpack may decrease kyphosis and pain related not only to compression fractures but also reduce iliocostal friction. Therapeutic exercise should address osteo - porosis-related deformities of axial posture, which can increase risk of fall and fracture. Thus, the role of a therapeutic exercise program is to increase muscle strength safely, decrease immobility-related complications, and prevent fall and fracture. As with pharmacotherapy, therapeutic exercises are individualized.

Download Full-text