Statins and the risk of pneumonia: a population-based, nested case-control study

STUDY OBJECTIVE: To determine if the use of statins affects pneumonia-related outpatient visits, hospitalizations with survival, and deaths. DESIGN: Population-based, retrospective, nested case-control analysis. DATA SOURCE: United Kingdom-based General Practice Research Database. PARTICIPANTS: The study population (134,262 patients aged > or = 30 yrs) consisted of 55,118 patients who took statins and/or fibrates, 29,144 patients with hyperlipidemia not taking lipid-lowering agents, and 50,000 randomly selected patients without hyperlipidemia and without lipid-lowering treatment. MEASUREMENTS AND MAIN RESULTS: We identified 1253 patients with pneumonia and matched them with 4838 control subjects based on age, sex, general practice, and index date. After adjusting for comorbidity and frequency of visits to general practitioners, we calculated the risks (odds ratios with 95% confidence intervals) of uncomplicated pneumonia, hospitalization for pneumonia with survival, and fatal pneumonia in participants who used statins compared with those who did not. Current statin users had a significantly reduced risk of fatal pneumonia (adjusted odds ratio 0.47, 95% confidence interval 0.25-0.88) and slightly but not significantly reduced risks of uncomplicated pneumonia and pneumonia hospitalization with survival. Recent or past statin use and fibrate use at any time were not associated with a reduced risk of pneumonia. CONCLUSION: Current use of statins was associated with a reduced risk of pneumonia. The risk reduction was particularly strong in the subgroup of patients with fatal pneumonias.     

Statin adherence and the risk of major coronary events in patients with diabetes: a nested case-control study

AIMS

To evaluate whether good statin adherence is associated with a reduced incidence of major coronary events (MCEs) among diabetic patients with and without coronary heart disease (CHD).

METHODS

Using data derived by linkage of nationwide health databases in Finland, we conducted a nested case–control analysis of 3513 cases with an MCE, a composite of acute myocardial infarction and/or coronary revascularization, and 20 090 matched controls identified from a cohort of 60 677 statin initiators with diabetes. Cases and controls were matched according to gender, time of cohort entry and duration of follow-up and further classified to two risk groups according to the presence of CHD at statin initiation. The incidence of MCEs was compared between patients with good statin adherence (the proportion of days covered ≥80%) and patients with poor statin adherence (<80%). Odds ratios (OR) for MCEs were estimated by conditional logistic regression adjusting for several covariables.

RESULTS

Good statin adherence was associated with a reduced incidence of MCEs in those with prior CHD [OR 0.84 (95% CI 0.74–0.95)] and in those without it [OR 0.86 (95% CI 0.78–0.95)]. The association persisted among those followed up for 5 years or longer [OR 0.77 (95% CI 0.58–1.02) and OR 0.79 (95% CI 0.66–0.94) respectively]. In sensitivity analyses, a reduced MCE incidence was observed also in those without any documented cardiovascular disease (CVD) at statin initiation [OR 0.87 (95% CI 0.78–0.96) overall and OR 0.80 (95% CI 0.66–0.97) for those followed up 5 years or longer].

CONCLUSIONS

In patients with diabetes, good adherence to statins predicts reduced incidence of MCEs irrespective of the presence of CHD at statin initiation.     

血浆瘦素水平与首发抑郁症临床症状的相关性研究

目的研究瘦素水平与首发抑郁症临床症状之间的相关性。方法选取40名首发抑郁症患者(2015年3~10月在湖州市第三人民医院心身科住院)作为病例组,通过汉密尔顿量抑郁量表(HAMD)测评临床症状,以40名健康人群作为对照组,两者均为男女各20例,测两组患者的血浆瘦素水平。结果 (1)不同性别的血浆瘦素水平具有统计学差异,女性血浆瘦素水平要高于男性血浆瘦素水平(P0.05)。病例组的血浆瘦素水平高于对照组,两者有统计学差异(P0.05)。(2)病例组的血浆瘦素水平与HAMD总分呈正相关(r=0.746,P0.05)。(3)病例组的血浆瘦素水平和HAMD的下列因子呈正相关:焦虑/躯体化因子(r=0.415,P0.05),睡眠障碍因子(r=0.409,P0.05)。结论 (1)女性的血浆瘦素水平要高于男性的血浆瘦素水平。(2)首发抑郁症患者的血浆瘦素水平要高于健康人群,瘦素水平越高,抑郁程度越重。     

Treatment of depression in first episode of schizophrenia: Results from EUFEST

Depressive symptomatology is an important target of treatment in first episode schizophrenia. This reanalysis of the European First Episode Schizophrenia Trial (EUFEST) describes the depressive symptomatology and the effect of antipsychotic treatment in patients suffering from first episode schizophrenia and schizophreniform disorder randomized to treatment with low dose haloperidol (n=103), amisulpride (n=104), olanzapine (n=105), quetiapine (n=104) or ziprasidone (n=82) for one year. At baseline, the mean score on the Calgary Depression Scale for Schizophrenia (CDSS) was 5.1 (±4.9) with 38.3% of patients having a CDSS score≥6, i.e. clinically relevant depressive symptom severity. During treatment depression scores decreased, the mean CDSS score being 1.1 (±2.1) and 3.0% of patients having a CDSS≥6 at 52 weeks. The proportion of patients using antidepressants during the complete trial was 18.5% in the haloperidol group, 28.6% in the olanzapine group compared to 5.8% in the quetiapine group, 12.5% in the amisulpride group, and 9.8% in the ziprasidone group. There were no differences over time in the probability of being depressed (CDSS≥6) between the 5 treatment groups after adjustment for antidepressant use, nor in a sub analysis of patients who did not take any antidepressant. Depression scores at baseline or during the trial had no effect on treatment discontinuation or on the reduction of positive symptoms. In summary, the results of EUFEST did not demonstrate a differential effect of the antipsychotics studied on depressive symptomatology in patients with first episode schizophrenia.     

Antidepressant agents for the treatment of chronic pain and depression

Depression and painful somatic symptoms commonly occur together. Depression and chronic pain can have devastating effects on a patient's health, productivity, and overall quality of life. When moderate-to-severe pain exists, it can impair patient function while making treatment more difficult or resistant, with increased severity in depressive symptoms and worse outcomes. A variety of chronic pain syndromes exist, including diabetic neuropathy. A high prevalence of patients with chronic pain display depressive symptoms. Treatment for these conditions relies on pharmacologic therapy coupled with diligent, periodic assessments of changes in symptom severity. The link between pain and depression lies in the central and peripheral nervous systems. The brain stem serves as an important connection between the higher brain centers and the spinal cord. In the brain stem, the neurotransmitters serotonin and norepinephrine modulate pain transmission through ascending and descending neural pathways. Both serotonin and norepinephrine are also key neurotransmitters involved with the pathophysiology of depression. Tricyclic antidepressants are effective treatments for pain and depression; selective serotonin reuptake inhibitors provide less benefit. Duloxetine and venlafaxine, which are serotonin and norepinephrine reuptake inhibitors, were shown in clinical trials to alleviate pain and depressive symptoms. Diabetic neuropathy and other chronic pain syndromes were also shown to benefit from duloxetine and venlafaxine. Antidepressants remain fundamental therapeutic agents for depression and anxiety disorders. Their extended use into chronic pain, depression with physical pain, physical pain with or without depression, and other potential medical conditions should be recognized.     

盐酸舍曲林和盐酸文拉法辛治疗首发抑郁症的疗效及不良反应比较

目的分别采用盐酸舍曲林和盐酸文拉法辛对首发抑郁症患者进行治疗,并对两种药物的疗效及不良反应发生情况进行比较。方法在我院2015年1~12月期间收治的首发抑郁症患者中选择62例作为此次研究的观察对象。根据治疗药物的不同将其分为两组,将采用盐酸舍曲林治疗的患者视为对照组(31例),将采用盐酸文拉法辛治疗的患者视为观察组(31例)。对两组患者治疗期间所发生的不良反应及治疗后的效果进行对比、分析。结果经过治疗,观察组的总有效率为93.55%,治疗1周后的HAMD评分为(19.66±1.44)分,不良反应发生率为19.35%;对照组的总有效率为83.87%,治疗1周后的HAMD评分为(25.91±1.05)分,不良反应发生率为22.58%。两组数据相比,发现两组患者的总有效率和不良反应发生率无明显差异(P0.05),但观察组治疗后的HAMD评分低于对照组,且差异显著(P0.05)。结论盐酸舍曲林和盐酸文拉法辛在治疗抑郁症中效果相当,不良反应均较少,安全性良好,但是盐酸文拉法辛更能有效缓解患者的抑郁情绪,可作为治疗抑郁症的首选药物。     

Tibolone and endometrial cancer: a cohort and nested case-control study in the UK.

OBJECTIVE: Case series and spontaneous reports of endometrial cancer have raised the question as to whether the use of tibolone (introduced into the UK in 1991) is associated with an increased risk of endometrial cancer. This study set out to evaluate whether tibolone use is associated with an increased risk of endometrial cancer. METHODS: Age-adjusted incidence rate ratios (IRRs) of endometrial cancer were calculated for tibolone use compared with the use of other hormone replacement therapy (HRT). Separate sets of controls, matched for age and general practice, were compared with cases, all nested within a cohort of HRT users identified from the UK General Practice Research Database (GPRD). Conditional logistic regression analysis, adjusted for potential confounders, was used to study the association between tibolone use and the risk of endometrial cancer. RESULTS: 4995 women used tibolone as their first HRT product; 10 783 (4.3%) of the users of combined HRT had changed to tibolone at some time during the study period. Amongst women whose HRT began with tibolone, the age-adjusted IRR relative to those who started with combined sequential HRT was 1.83 (95% CI 1.19, 2.82). The nested case-control study comprised 162 cases, each matched to two sets of 972 controls. There were 43 tibolone-exposed subjects, 28 of whom had used other HRT before or after tibolone. The adjusted odds ratio of the risk of endometrial cancer in women who had ever used tibolone, compared with users of combined sequential HRT, was 1.54 (95% CI 1.03, 2.32) in the age-matched set and 1.58 (95% CI 1.01, 2.47) in the practice-matched set. Sensitivity analyses did not decrease the risk estimates found. DISCUSSION: Tibolone may be associated with an increased risk of endometrial cancer compared with conventional forms of HRT, but our data are fragile. Residual bias and uncontrolled confounding cannot be excluded, and follow-up time is insufficient to draw any firm conclusions with respect to the endometrial safety of tibolone.