HMG-CoA reductase inhibitors and the risk of hip fractures in elderly patients

CONTEXT: Recent animal studies have found that 3-hydroxy-3-methylglutaryl coenzyme A (HMG-CoA) lipid-lowering drugs (statins) substantially increase bone formation, but whether statin use in humans results in clinically meaningful bone formation or a reduction in the risk of osteoporotic fractures is not known. OBJECTIVE: To determine whether the use of statins is associated with reduced hip fracture risk. DESIGN: Case-control study. SETTING AND PATIENTS: A total of 6110 New Jersey residents aged 65 years or older and enrolled in Medicare and either Medicaid or the Pharmacy Assistance for the Aged and Disabled program. Case patients (n=1222) underwent surgical repair of a hip fracture in 1994. Control patients (n=4888) were identified at a ratio of 4:1 and frequency-matched to case patients for age and sex. MAIN OUTCOME MEASURE: Adjusted odds ratio (OR) of hip fracture by statin use in the 180 days and 3 years prior to the index date (the earliest date of admission for surgery), adjusted for demographic and clinical characteristics and health care utilization. RESULTS: Use of statins in either the prior 180 days (adjusted OR, 0.50; 95% confidence interval [CI], 0.33-0.76) or prior 3 years (adjusted OR, 0.57; 95% CI, 0.40-0.82) was associated with a significant reduction in the risk of hip fracture, even after controlling for variables such as race, insurance status, psychoactive medications, estrogen and thiazide use, ischemic heart disease, cancer, and diabetes mellitus. No significant relationship was observed between use of nonstatin lipid-lowering agents and hip fracture risk. Clear relationships were observed between the degree of reduction in hip fracture risk and the extent of statin use; there was no evidence of such relationships with nonstatin lipid-lowering agents. After adjusting for extent of statin use in the prior 3 years, current use (on the index date) was associated with a 71% reduction in risk (adjusted OR, 0.29; 95% CI, 0.10-0.81). The relationship between statin use and hip fracture risk persisted after controlling for variables such as the number of medications, the Charlson comorbidity index score, and hospitalization or nursing home stay in the last 180 days, as well as after excluding patients who were in a nursing home prior to their index date or who died in the year after their index date. Use of nonstatin lipid-lowering agents was not observed to be associated with reduction in hip fracture risk in any of these alternative models or analyses. CONCLUSIONS: These findings support an association between statin use by elderly patients and reduction in the risk of hip fracture. Controlled trials are needed to exclude the possibility of unmeasured confounders. JAMA. 2000;283:3211-3216     

Use of statins and risk of fractures

CONTEXT: Previous studies have reported lower fracture risks in patients taking 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors (statins). OBJECTIVE: To investigate risk of fracture among statin users. DESIGN: Case-control study of data from the General Practice Research Database (GPRD). SETTING: A total of 683 general clinical practices in the United Kingdom. PATIENTS: Cases were 81 880 patients aged 50 years or older who had a fracture of the vertebrae, clavicle, humerus, radius/ulna, carpus, hip, ankle, or foot occurring between the enrollment date of their practice into the GPRD and July 1999, paired with 81 880 age-, sex-, and practice-matched controls. MAIN OUTCOME MEASURE: Risk of fracture in current users vs nonusers of statins. Odds ratios were estimated from conditional logistic regression and adjusted for smoking, medications and illnesses associated with fracture risk, and body mass index when known. RESULTS: The adjusted odds ratio (OR) for current use of statins compared with nonuse was 1.01 (95% confidence interval [CI], 0.88-1.16). For forearm, hip, and vertebral fractures, the ORs were 1.01 (95% CI, 0.80-1.27), 0.59 (95% CI, 0.31-1.13), and 1.15 (95% CI, 0.62-2.14), respectively. Relative to nonuse, a statin dosage of less than 20 mg/d (standardized to simvastatin) was associated with an adjusted OR of fracture of 1.13 (95% CI, 0.96-1.33); this OR was 1.07 (95% CI, 0.82-1.38) at dosages of 20 to 39.9 mg/d and 0.85 (95% CI, 0.47-1.53) at dosages of 40 mg/d or more. The adjusted OR was 0.71 (95% CI, 0.50-1.01) for statin use durations of 0 to 3 months, 1.31 (95% CI, 0.87-1.95) for durations of 3 to 6 months, 1.14 (95% CI, 0.82-1.58) for durations of 6 to 12 months, and 1.17 (95% CI, 0.99-1.40) for durations of more than 12 months. CONCLUSION: In this study, use of statins at dosages prescribed in clinical practice was not associated with a reduction in risk of fracture.     

Utilization of statins and aspirin among patients with diabetes and hyperlipidemia: Taiwan, 1998–2006

BackgroundThe proper use of statins and aspirin decrease the risk of coronary heart disease (CHD) among patients with diabetes (DM) and hyperlipidemia. The purpose of this study was to analyze the time trends and determinants of prescribing statins and aspirin among patients with DM and hyperlipidemia in medical practice in Taiwan.MethodsA cohort of 21,667 patients with DM and hyperlipidemia during the period from 1998 to 2006 was identified by using data of ambulatory care claims from Taiwan's National Health Insurance Database. The dataset was categorized into two equal calendar periods: Period 1 (September 1998–June 2002) and Period 2 (July 2002–April 2006). Multivariate logistic regression analyses were used to determine the independent determinants associated with receipt of lipid-lowering agents and aspirin among these patients.ResultsThere were significant increases in the prescribing of statins (OR 1.78; 95% CI 1.66?1.91) and aspirin (OR 1.47, 95% CI 1.50?1.59) in Period 2 as compared with Period 1. Nevertheless, 30% of patients with coexisting CHD neither received statins nor aspirin. Only 15% to 25% of DM patients with hyperlipidemia and CHD received the combined treatment with aspirin and statin. In multivariate logistic regression, we found that women received aspirin less frequently than men. Old patients (>45 years) with concomitant CHD were more likely to receive statins and aspirin.ConclusionDespite the increasing trend in the use of statins and aspirin in DM patients with hyperlipidemia in Taiwan, the improvements were at best modest, particularly for secondary prevention. Our data indicate the need for continued efforts to improve the utilization of these drugs in daily practice.     

Risk factors for delirium in hospitalized elderly.

OBJECTIVE--To determine risk factors for delirium in elderly hospitalized patients. DESIGN--Cohort analytic study. Using a reliable and valid instrument for detection of delirium, we prospectively followed up a cohort of elderly patients admitted to an acute care hospital. Using standardized criteria, we collected risk factor data from patient medical records. SETTING--General medical and surgical wards of a tertiary-care hospital. PATIENTS--Patients (n = 325) were 65 years of age or older, from either a geographically defined community or a long-term-care institution. We studied those patients (n = 291) not delirious on first evaluation. Fifty-seven patients or their families refused participation. MAIN OUTCOME MEASURES--Incidence of delirium and risk factors calculated as adjusted odds ratios (ORs). MAIN RESULTS--Delirium developed in 91 patients. By stepwise logistic regression, the independent risk factors for in-hospital delirium included prior cognitive impairment (OR, 8.97; 95% confidence interval [CI], 3.99 to 20.14), age over 80 years (OR, 5.22; 95% CI, 2.60 to 10.46), fracture on admission (OR, 6.57; 95% CI, 2.23 to 19.33), symptomatic infection (OR, 2.96; 95% CI, 1.42 to 6.15), and male sex (OR, 2.40; 95% CI, 1.19 to 4.84). Among medication groups, only neuroleptic use (OR, 4.48; 95% CI, 1.82 to 10.45) and narcotic use (OR, 2.54; 95% CI, 1.24 to 5.18) were independently associated with delirium. Anticholinergic use was not associated with delirium. CONCLUSIONS--Delirium in hospitalized patients is most closely associated with factors already present on admission such as prior cognitive impairment, advanced age, and fracture. In the hospital, use of neuroleptics and narcotics and the presence of infection are less strongly associated with this syndrome.     

Lifetime events and posttraumatic stress disorder in 4 postconflict settings

CONTEXT: Little is known about the impact of trauma in postconflict, low-income countries where people have survived multiple traumatic experiences. OBJECTIVE: To establish the prevalence rates of and risk factors for posttraumatic stress disorder (PTSD) in 4 postconflict, low-income countries. DESIGN, SETTING, AND PARTICIPANTS: Epidemiological survey conducted between 1997 and 1999 among survivors of war or mass violence (aged >/=16 years) who were randomly selected from community populations in Algeria (n = 653), Cambodia (n = 610), Ethiopia (n = 1200), and Gaza (n = 585). MAIN OUTCOME MEASURE: Prevalence rates of PTSD, assessed using the PTSD module of the Composite International Diagnostic Interview version 2.1 and evaluated in relation to traumatic events, assessed using an adapted version of the Life Events and Social History Questionnaire. RESULTS: The prevalence rate of assessed PTSD was 37.4% in Algeria, 28.4% in Cambodia, 15.8% in Ethiopia, and 17.8% in Gaza. Conflict-related trauma after age 12 years was the only risk factor for PTSD that was present in all 4 samples. Torture was a risk factor in all samples except Cambodia. Psychiatric history and current illness were risk factors in Cambodia (adjusted odds ratio [OR], 3.6; 95% confidence interval [CI], 2.3-5.4 and adjusted OR,1.6; 95% CI, 1.0-2.7, respectively) and Ethiopia (adjusted OR, 3.9; 95% CI, 2.0-7.4 and adjusted OR, 1.8; 95% CI, 1.1-2.7, respectively). Poor quality of camp was associated with PTSD in Algeria (adjusted OR, 1.8; 95% CI, 1.3-2.5) and in Gaza (adjusted OR, 1.7; 95% CI, 1.1-2.8). Daily hassles were associated with PTSD in Algeria (adjusted OR, 1.6; 95% CI, 1.1-2.4). Youth domestic stress, death or separation in the family, and alcohol abuse in parents were associated with PTSD in Cambodia (adjusted OR, 1.7; 95% CI, 1.1-2.6; adjusted OR, 1.7; 95% CI, 1.0-2.8; and adjusted OR, 2.2; 95% CI, 1.1-4.4, respectively). CONCLUSIONS: Using the same assessment methods, a wide range of rates of symptoms of PTSD were found among 4 low-income populations who have experienced war, conflict, or mass violence. We identified specific patterns of risk factors per country. Our findings indicate the importance of contextual differences in the study of traumatic stress and human rights violations.     

甲状腺结节检出情况及影响因素： 10年309 576例体检人群分析

目的 了解广东省健康体检人群甲状腺结节检出情况并分析相关影响因素。方法 回顾分析近10 年广东省某医院309 576 例体检人员甲状腺彩超检查情况。将人群分为甲状腺结节组与非甲状腺结节组,使用SPSS22.0软件,组间比较根据数据类型分别用两独立样本t检验、Mann-Whitney U检验及χ2检验进行分析,用二元logistic回归分析不同影响因素与甲状腺结节之间的关系,计算比值比（OR）与95%置信区间（95% CI）。结果 经过数据结构化和标准化,甲状腺结节总检出率为9.68%,其中男性为7.71%,女性为13.51%,差异有统计学意义（χ2=2677.08,P<0.001）。总体上,甲状腺结节检出率随年龄增长而逐渐升高;不同年龄段,女性检出率均高于男性,差异有统计学意义（P<0.001）。甲状腺结节组男性比例、年龄、BMI、SBP、DBP、FBG、TC、LDL-C、HDL-C、TG及脂肪肝、血脂异常、血糖偏高、代谢综合征检出率均高于非甲状腺结节组,且差异有统计学意义（P<0.001）。二元logistic回归分析显示,甲状腺结节与性别（OR=0.455,95%CI: 0.443-0.468）、年龄（45~59：OR=1.660,95%CI:1.613-1.710;≥60岁：OR=3.329,95%CI: 3.202-3.462）、BMI （体质量偏轻：OR=0.808,95%CI: 0.755-0.864;超重：OR=1.074,95%CI: 1.038-1.112;肥胖：OR=1.281,95%CI: 1.221-1.343）、血脂异常（OR=1.053,95%CI: 1.022-1.085）、血糖偏高（OR=1.177,95%CI: 1.105-1.252）、及代谢综合征（OR=1.111,95%CI: 1.071-1.152）有关。结论 广东省某医院体检人群中女性甲状腺结节检出率明显高于男性。性别、年龄、BMI及代谢相关疾病为重要影响因素。男性、体质量偏轻可能是甲状腺结节的保护因素,而年龄增长、超重/肥胖、血脂异常、血糖偏高及代谢综合征可能使甲状腺结节检出风险提高。因此,在健康体检人群中普及甲状腺彩超检查对甲状腺疾病早期防治有重要的临床意义。     

锯齿状息肉与传统腺瘤风险因素对比及结直肠癌适宜筛查年龄

目的 对锯齿状息肉(SPs)及传统腺瘤(CA)相关风险因素进行分析、对比,探讨两类息肉风险因素间异同.方法 收集南方医院消化内镜中心2012～2015行全结肠镜及息肉病理检查的病例.随机选取健康对照103例,SPs100例,CA 115例,采集各病例性别、年龄、身高、体质量等临床数据.运用SPSS软件,先对各因素进行组间多重比较,对具有显著性的因素再纳入多因素logistic回归分析,得到风险因素及其OR值.结果 SPs平均发病年龄48.87岁(95％CI 47.22-50.52),较CA更早(P=0.038).以青年组为参照,中年组发生SPs风险增加2.31倍(95％CI 1.46-3.65)、CA风险增加4.10倍(95％CI 2.50-6.72);老年组发生SPs风险增加2.77倍(95％CI 1.52-5.04)、CA风险增加6.00倍(95％CI 3.26-11.05).其中,年龄与CA的发生较SPs关系更为密切(老年组:OR=2.14,95％CI 1.21-3.78,P=0.009).男性较女性SPs发病风险增加2.75倍(95％CI 1.50-5.07)、CA增加2.19倍(95％CI1.22-3.95).BMI每增加1个单位,SPs发病风险增加1.18倍(95％CI 1.06-1.30)、CA增加1.20倍(95％CI 1.09-1.32).结论 两类息肉风险因素类别相同,可使用同一方案进行高危人群筛查.SPs平均发病年龄早于50岁且有可能快速进展为癌,提早CRC筛查年龄值得考虑.     

Hepatitis B virus infection among street youths in Montreal

BACKGROUND: Street youths are at high risk for many health problems, including sexually transmitted diseases and bloodborne infections. The authors conducted a cross-sectional anonymous study from December 1995 to September 1996 involving street youths in Montreal to estimate the prevalence of risk behaviours for hepatitis B virus (HBV) infection and of markers of past and present HBV infection. METHODS: Participants were 437 youths aged 14 to 25 meeting specific criteria for itinerancy who were recruited in collaboration with the 20 major street youth agencies in Montreal. Sociodemographic and lifetime risk factor data were obtained during a structured interview, and a blood sample was taken to test for HBV markers (hepatitis B surface antigen and antibodies to the hepatitis B core antigen). Univariate analyses and multivariate logistic regressions were conducted. RESULTS: The mean age of the subjects was 19.5 years; 69.3% (303/437) were males. Many subjects had high-risk behaviours: 45.8% (200/437) had injected drugs, 24.5% (107/436) had engaged in prostitution, and 8.7% (38/437) reported having a sexual partner with a history of unspecified hepatitis. The prevalence rate for one or both HBV markers was 9.2% (40/434) (95% confidence interval [CI] 6.7%-12.3%). Multivariate logistic regression analysis showed that being over 18 years of age (adjusted odds ratio [OR] 4.5, 95% CI 1.8-11.7), having injected drugs (adjusted OR 3.5, 95% CI 1.5-8.3) and having had a sexual partner who had unspecified hepatitis (adjusted OR 3.2, 95% CI 1.3-7.5) were all associated with HBV infection. INTERPRETATION: Street youths are at high risk for HBV infection. Early and complete HBV vaccination among this vulnerable population is urgently needed.     

Impact of frequency of intercourse on erectile dysfunction: A cross-sectional study in Wuhan, China

This study was aimed to investigate the influence of coital frequency and masturbation on erectile dysfunction (ED) in Chinese patients. A total of 332 male outpatients with or without ED and volunteers were recruited from Zhongnan Hospital, Wuhan University, China. ED was assessed by using the five-item International Index of Erectile Function scale and the frequency of intercourse by patients’ self-report. After adjusting for lifestyle factors and diseases-related factors, the analyses showed that coital and masturbation in a certain frequency tended to decrease the risk of ED. Men reporting intercourse once a week had lower risk of ED than those did less than once a week, with age, hyperlipidemia, hy-pertension, diabetes, body mass index, smoking, and drinking as covariates (P=0.67, adjusted odds ratio [OR] = 0.84; 95% confidence interval [CI]: 0.37-1.88). For those reporting coital frequency two times per week and three or more times per week, there were 63% (adjusted OR = 0.37; 95% CI: 0.18-0.77) and 85% (adjusted OR = 0.15; 95% CI: 0.07-0.35) lower risk of ED than those reporting intercourse frequency less than once per week, respectively (P<0.05). Results indicated that maintaining a regular frequency of intercourse can reduce the risk of ED for males aged among 30 to 75 years.     

Calcium-channel blockers and cognitive function in elderly people: results from the Canadian Study of Health and Aging

BACKGROUND: Concern has been raised about the potential for adverse cognitive effects associated with the use of calcium-channel blockers (CCBs) in older people. This study was undertaken to examine prospectively the association between the use of these and other antihypertensive drugs and cognitive function. METHODS: The authors examined data from the Canadian Study of Health and Aging (CSHA), a population-based, prospective 5-year investigation of the epidemiology of dementia and other health problems in Canadians 65 years of age and older. The risk of cognitive decline, as indicated by a decline in performance on the Modified Mini-Mental State (3MS) examination over the 5-year period, was assessed in relation to the use of antihypertensive and diuretic drugs by 205 subjects with a history of hypertension and no evidence of dementia at baseline. RESULTS: The proportion of subjects whose cognitive performance declined over the study period was significantly higher in the group using CCBs than in the group using other antihypertensive agents (75% v. 59%). The adjusted odds ratio (OR) for a significant decline in cognitive performance (defined as a decrease in 3MS score of 10 points or more) was 2.28 (95% confidence interval [CI] 1.12-4.66) for subjects using CCBs. The adjusted ORs (and 95% CIs) for cognitive decline in subjects using selected antihypertensive agents or diuretics relative to those exposed to beta-blockers were as follows: angiotensin-converting-enzyme inhibitor, OR 1.36 (95% CI 0.41-4.55); diuretic or other antihypertensive drug, OR 1.45 (95% CI 0.51-4.14); dihydropyridine CCB (nifedipine), OR 1.94 (95% CI 0.52-7.27) and non-dihydropyridine CCB (diltiazem or verapamil), OR 3.72 (95% CI 1.22-11.36). INTERPRETATION: Older people taking CCBs were significantly more likely than those using other agents to experience cognitive decline. These findings are consistent with the results of previous cross-sectional research and emphasize the need for further trials to examine the associations between CCB use, blood pressure and cognitive impairment in elderly patients.