JURNAL READING

Statins and the Risk of Herpes Zoster:

A Population-Based Cohort Study

Mohamad Syaikhul Islam

29.02.1160.2013
 Background
• Herpes Zoster (HZ) incidence and severity
increase with age
• 60 % incidence occuring in aged >50 years
• Became a burden because its morbidity and
healthcare cost
 Background (2)

Inhihibit HMG ↓ isoprenoid ↓ Ras-related

CoA pyrophosphates GTPases

Involved in antigen endocytosis, imunologic synapse

formation, and costimulary molecule expression

T cell proliferation and

activation impared
 Background (3)

Suppress Th1-
Induced Th2 cell
Statins differentiation
immune
responses
Involved in
controlling VZV
1. Examined the risk of herpes zoster in replication
the subset of patients with diabetes
2. examined the association between
statin exposure and knee arthroplasty.
 Methods
• Cohort study of Ontario residents aged ≥66
years between 1 April 1997 and 31 March
2010
1. Ontario Drug Benefit Database
• Data Source
2. Canadian Institute for Health Information's Discharge
Abstract Database
3. National Ambulatory Care Reporting System
4. Ontario Diabetes Database
5. Ontario Health Insurance Plan database
6. Registered Persons Database
 Methods (2)
Patients receiving +
statins
-

+
Nonusers
-
Matching :
•Sex
•Year of Cohort Entry Statistical Analysis :
•Propensity score Cox proportional hazards
•Age at index date
•Presence of Diabetes
 Results

Patients receiving
494 651 13.25
statins

Nonusers 494 651 11.71

19 143 / 1000 person-

occurred HZ years

Hazard ratio 1.13

Results (2)
 Results (3)
• Similar risk of HZ among statin users in the
subgroup of patient with DM
• Dose response analysis
– No appreciable difference in the risk of HZ with
moderate or high doses relative to low dose of
thesese group
• No association between statin use and knee
arthroplasty
 Discussion
• Statin-treated patients were at an increased
risk of developing herpes zoster relative to
individuals who were not prescribed these
drugs.

morbidity

HZ and its
sequelae ↓ QoL

Cost >$1 billion

 Discussion
• Estimate nearly 20 000 of HZ episode could be
attributable to statin use
• Whom statin theraphy is required, provision of
the HZ vaccine could be considered

Reappraisal
of statin low risk CVD
theraphy
 Discussion (3)
• Study limitation
– Biased by unmeasured confounder or intergroup
differences in baseline risk of HZ
– No access to serum cholesterol
– Measures of adherence to statin drugs
 Summary

• Statins are associated with an increased risk of

herpes zoster in older patients.
• Needed to clarify the exact mechanisms
through which statins promote VZV
reactivation
• Whether this findings are generalizable to
younger patients receiving these drugs