title: The effect of statin therapy on the incidence of infections: a retrospective cohort analysis.
abstract: BACKGROUND
  Statins have been postulated to prevent infection through immunomodulatory effects.
  
  
  OBJECTIVE
  To compare the incidence of infections in statin users to that in nonusers within the same health care system.
  
  
  METHODS
  This was a retrospective cohort study of patients enrolled as Tricare Prime or Plus in the San Antonio military multimarket. Statin users were patients who received a statin for at least 3 months between October 1, 2004 and September 30, 2005. Nonusers were patients who did not receive a statin within the study period (October 1, 2003-September 30, 2009). Inpatient and outpatient International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) codes were used to determine the incidence of infections during the follow-up period (October 1, 2005-September 30, 2009) via multivariable regression analysis and time to infection via Cox regression analysis.
  
  
  RESULTS
  Of 45,247 patients who met the study criteria, 12,981 (29%) were statin users and 32,266 were nonusers. After adjustments for age, gender, Charlson Comorbidity Score, tobacco use, alcohol abuse/dependence, health care utilization and use of specific medication classes, statin use was associated with an increased incidence of common infections (odds ratio [OR]: 1.13; 95% confidence interval [CI]: 1.06-1.19) but not influenza or fungal infections (OR: 1.06, 95% CI: 0.80-1.39; OR: 0.97; 95% CI: 0.91-1.04, respectively). Time-to-first infection was similar in statin users and nonusers in all infection categories examined.
  
  
  CONCLUSIONS
  Statin use was associated with an increased incidence of common infections but not influenza or fungal infections. This study does not support a protective role of statins in infection prevention; however, the influence of potential confounders cannot be excluded.
authors: Department of Internal Medicine (JPM, SKA), San Antonio Military Medical Center, San Antonio, Texas; College of Pharmacy (CRF, KRD), The University of Texas at Austin, Austin, Texas; Pharmacotherapy Education and Research Center (CRF, KRD), School of Medicine, University of Texas Health Science Center, San Antonio, Texas; VA North Texas Health Care System (EMM); University of Texas Southwestern Medical Center (EMM), Dallas, Texas; South Texas Veterans Health Care System (MJP); Department of Epidemiology and Biostatistics (MJP), University of Texas Health Science Center, San Antonio, Texas; Division of Pharmaceutical Outcomes and Policy (CUO), UNC Eshelman School of Pharmacy, University of North Carolina, Chapel Hill, North Carolina; Brooke Army Medical Center (IAM); and Uniformed Service University of Health Sciences (IAM); University of Texas Health Science Center, San Antonio, Texas (IAM).
authors: John P
authors: JP
authors: Magulick
authors: Christopher R
authors: CR
authors: Frei
authors: Sayed K
authors: SK
authors: Ali
authors: Eric M
authors: EM
authors: Mortensen
authors: Mary Jo
authors: MJ
authors: Pugh
authors: Christine U
authors: CU
authors: Oramasionwu
authors: Kelly R
authors: KR
authors: Daniels
authors: Ishak A
authors: IA
authors: Mansi
mesh_terms: D000328:Adult; D000368:Aged; D001424:Bacterial Infections / Q000453:epidemiology*; D005260:Female; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use*; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009181:Mycoses / Q000453:epidemiology*; D011014:Pneumonia / Q000453:epidemiology; D012141:Respiratory Tract Infections / Q000453:epidemiology*; D012189:Retrospective Studies; D012871:Skin Diseases / Q000453:epidemiology; D013781:Texas / Q000453:epidemiology; D014552:Urinary Tract Infections / Q000453:epidemiology
chemical_list: D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors