title: Statin use associated with a reduced risk of pneumonia requiring hospitalization in patients with myocardial infarction: a nested case-control study.
abstract: BACKGROUND
  Statins have been reported to prevent adverse cardiovascular events in patients with myocardial infarction (MI). However, the association of statin use and the risk of pneumonia requiring hospitalization in MI patients remains unclear.
  
  
  METHODS
  A nested case-control study was conducted by using data from the National Health Insurance Research Database of Taiwan. Among 24,975 patients with MI, 2686 case patients with pneumonia requiring hospitalization were age- and sex-matched with 10,726 control patients using the incidence density sampling approach. Duration and dosage of statin use were obtained from pharmaceutical claims. Conditional logistic regression analyses were used to estimate the risk of hospitalization for pneumonia associated with statin use adjusted for patient's demographics, medical conditions and prescribed medications.
  
  
  RESULTS
  Statin use was associated with a 15% reduced risk of pneumonia requiring hospitalization among MI patients (adjusted odds ratio [aOR] = 0.85, 95% confidence interval [CI] = 0.77-0.95, P = 0.004). The association was more significant for MI patients unexposed to statin pretreatment (aOR = 0.76, 95% CI = 0.64-0.90, P = 0.001). Statins also exhibited favorable benefits in a time- and dose-dependent manner. The results were consistent in various subgroup analysis of the patients who were female, age ≥ 65 years, a low CHADS2 (i.e. congestive heart failure, hypertension, diabetes mellitus, previous stroke and age > 75 years old) score, and fewer comorbidities. Atorvastatin, fluvastatin and simvastatin were the most common prescribed statins and had similar effects.
  
  
  CONCLUSIONS
  Statins might be considered as an adjunctive therapy to reduce the risk of hospitalization for pneumonia for MI patients under thorough evaluation of individual comorbidities, previous statin use and optimal dosage.
authors.affiliation: Division of Cardiology, Department of Internal Medicine, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan. 12000@s.tmu.edu.tw.|Division of Cardiology, Department of Internal Medicine, MacKay Memorial Hospital, Taipei, Taiwan. 12000@s.tmu.edu.tw.|Department of Medicine, Mackay Medical College, New Taipei, Taiwan. 12000@s.tmu.edu.tw.
authors.forename: Chao-Feng
authors.initials: CF
authors.lastname: Lin
authors.affiliation: Pharmacy Department of Mackay Memorial Hospital, Taipei, Taiwan. yahui057@gmail.com.
authors.forename: Ya-Hui
authors.initials: YH
authors.lastname: Chang
authors.affiliation: Division of Cardiology, Department of Internal Medicine, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan. liumdcv@s.tmu.edu.tw.
authors.forename: Ju-Chi
authors.initials: JC
authors.lastname: Liu
authors.affiliation: School of Public Health, College of Public Health and Nutrition, Taipei Medical University, Taipei, Taiwan. chen6367@gmail.com.
authors.forename: Ming-Tsang
authors.initials: MT
authors.lastname: Chuang
authors.affiliation: School of Health Care Administration, College of Management, Taipei Medical University, Taipei, Taiwan. lnchien@tmu.edu.tw.
authors.forename: Li-Nien
authors.initials: LN
authors.lastname: Chien
mesh_terms: D000368:Aged; D000069059:Atorvastatin / Q000627:therapeutic use; D016022:Case-Control Studies; D015897:Comorbidity; D003920:Diabetes Mellitus / Q000453:epidemiology; D005229:Fatty Acids, Monounsaturated / Q000627:therapeutic use; D005260:Female; D000077340:Fluvastatin; D006333:Heart Failure / Q000453:epidemiology; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use*; D006973:Hypertension / Q000453:epidemiology; D015994:Incidence; D007211:Indoles / Q000627:therapeutic use; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000188:drug therapy* / Q000453:epidemiology; D016017:Odds Ratio; D011014:Pneumonia / Q000453:epidemiology*; D065840:Protective Factors; D012189:Retrospective Studies; D012307:Risk Factors; D019821:Simvastatin / Q000627:therapeutic use; D020521:Stroke; D013624:Taiwan / Q000453:epidemiology
chemical_list: D005229:Fatty Acids, Monounsaturated; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D007211:Indoles; D000077340:Fluvastatin; D000069059:Atorvastatin; D019821:Simvastatin
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