statin induced myopathy and myalgia time trend analysis and comparison of risk associated with statin class from 1991–2006他汀类药物诱导肌病和肌痛时间趋势分析和比较相关的风险与他汀类从1991 - 2006.pdf

Statin Induced Myopathy and Myalgia: Time Trend Analysis and Comparison of Risk Associated with Statin Class from 1991–2006 1 2 3 4 Mariam Molokhia *, Paul McKeigue , Vasa Curcin , Azeem Majeed 1 Department of Epidemiology Population Health, London School of Hygiene Tropical Medicine, London, United Kingdom, 2 Public Health Sciences, University of Edinburgh Medical School, Edinburgh, United Kingdom, 3 Department of Computing, Imperial College London, London, United Kingdom, 4 Department of Primary Care and Social Medicine, Imperial College, London, United Kingdom Abstract Background: Statins are widely used as a cholesterol lowering medication, reduce cardiovascular mortality and morbidity in high risk patients; and only rarely cause serious adverse drug reactions (ADRs). UK primary care databases of morbidity and prescription data, which now cover several million people, have potential for more powerful analytical approaches to study ADRs including adjusting for confounders and examining temporal effects. Methods: Case-crossover design in detecting statin associated myopathy ADR in 93, 831 patients, using two independent primary care databases (1991–2006). We analysed risk by drug class, by disease code and cumulative year, exploring different cut-off exposure times and confounding by temporality. Results: Using a 12 and 26 week exposure period, large risk ratios (RR) are associated with all classes of statins and fibrates for myopathy: RR 10.6 (9.8–11.4) and 19.9 (17.6–22.6) respectively. At 26 weeks, the largest risks are with fluvastatin RR 33.3 (95% CI 16.8–66.0) and ciprofibrate (with previous statin use) RR 40.5 (95% CI 13.4–122.0). AT 12 weeks the differences between cerivastatin and atorvastatin RR for myopathy were found to be sign