title: Statin use is associated with a decreased risk of Barrett's esophagus.
abstract: OBJECTIVE
  Statins have been associated with a reduced risk of esophageal adenocarcinoma, but little is known about their effect on development of Barrett's esophagus. We evaluated the association between statins and risk of Barrett's esophagus.
  
  
  METHODS
  We conducted a case-control study among eligible patients scheduled for elective esophagogastroduodenoscopy and patients eligible for screening colonoscopy, recruited from primary care clinics at a Veterans Affairs center. We compared 303 patients with Barrett's esophagus with 2 separate sex-matched control groups: 606 elective endoscopy controls and 303 primary care controls without Barrett's esophagus. Use of statins and other lipid-lowering medications was ascertained by reviewing filled prescriptions in electronic pharmacy records during a 10-year period before the Barrett's esophagus diagnosis date for patients and study endoscopy date for controls. We calculated odds ratios (OR) and 95% confidence intervals (CI) using conditional multivariable logistic-regression models among 276 patients and 828 controls further matched on age.
  
  
  RESULTS
  A smaller proportion of Barrett's esophagus patients filled statin prescriptions (57.4%) than endoscopy controls (64.9%; P = .029) or primary care controls (71.3%; P < .001). Controls had longer durations of statin prescriptions filled than patients (28.6 vs 22.1 months; P = .001). Statin use was associated with a significantly lower risk of Barrett's esophagus (adjusted OR = 0.57; 95% CI: 0.38-0.87) compared with the combined control groups. The risk of Barrett's esophagus was especially lower with statin use among obese patients (OR = 0.26; 95% CI: 0.09-0.71), as was the risk for Barrett's esophagus segments ≥ 3 cm (OR = 0.13; 95% CI: 0.06-0.30). We found no significant association between Barrett's esophagus and nonstatin lipid-lowering medications (P = .452).
  
  
  CONCLUSIONS
  In a case-control study of veterans, statin use was associated with a reduced risk of Barrett's esophagus. The greatest level of risk reduction was observed for obese patients and for long-segment Barrett's esophagus.
authors.affiliation: Houston Veterans Affairs Health Services Research and Development Center for Innovations in Quality, Effectiveness and Safety, Houston, Texas; Department of Medicine, Baylor College of Medicine, Houston, Texas; Department of Pathology, Baylor College of Medicine, Houston, Texas.
authors.forename: Theresa
authors.initials: T
authors.lastname: Nguyen
authors.affiliation: Department of Medicine, Baylor College of Medicine, Houston, Texas; Department of Pathology, Baylor College of Medicine, Houston, Texas.
authors.forename: Natalia
authors.initials: N
authors.lastname: Khalaf
authors.affiliation: Houston Veterans Affairs Health Services Research and Development Center for Innovations in Quality, Effectiveness and Safety, Houston, Texas.
authors.forename: David
authors.initials: D
authors.lastname: Ramsey
authors.affiliation: Houston Veterans Affairs Health Services Research and Development Center for Innovations in Quality, Effectiveness and Safety, Houston, Texas; Department of Medicine, Baylor College of Medicine, Houston, Texas; Department of Pathology, Baylor College of Medicine, Houston, Texas; Department of Medicine, Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas; Department of Pathology, Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas; Section of Gastroenterology and Hepatology, Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas. Electronic address: hasheme@bcm.edu.
authors.forename: Hashem B
authors.initials: HB
authors.lastname: El-Serag
mesh_terms: D000368:Aged; D001471:Barrett Esophagus / Q000209:etiology / Q000473:pathology / Q000517:prevention & control*; D016022:Case-Control Studies; D011307:Drug Prescriptions; D050171:Dyslipidemias / Q000150:complications / Q000188:drug therapy*; D016145:Endoscopy, Digestive System; D005260:Female; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009765:Obesity / Q000150:complications; D016017:Odds Ratio; D011237:Predictive Value of Tests; D012307:Risk Factors; D014481:United States; D014493:United States Department of Veterans Affairs
chemical_list: D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors
keywords: Epidemiology; HMG-CoA Reductase; Obesity; Pharmacoepidemiology; Risk Factors; Simvastatin; Veterans Affairs