Risk of COPD Exacerbations Associated with Statins versus Fibrates: A New User, Active Comparison, and High-Dimensional Propensity Score Matched Cohort Study
Shu-Hui Sun,1 Chia-Hsuin Chang,2– 4 Zhe-Wei Zhan,5 Wen-Hsuan Chang,5 Yu-An Chen,6 Yaa-Hui Dong5– 7 1Department of Pharmacy, Far Eastern Memorial Hospital, Banciao, New Taipei City, Taiwan; 2Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan; 3Department of Medicine,...
| Main Authors: | , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Dove Medical Press
2021-10-01
|
| Series: | International Journal of COPD |
| Subjects: | |
| Online Access: | https://www.dovepress.com/risk-of-copd-exacerbations-associated-with-statins-versus-fibrates-a-n-peer-reviewed-fulltext-article-COPD |
| _version_ | 1819045505686044672 |
|---|---|
| author | Sun SH Chang CH Zhan ZW Chang WH Chen YA Dong YH |
| author_facet | Sun SH Chang CH Zhan ZW Chang WH Chen YA Dong YH |
| author_sort | Sun SH |
| collection | DOAJ |
| description | Shu-Hui Sun,1 Chia-Hsuin Chang,2– 4 Zhe-Wei Zhan,5 Wen-Hsuan Chang,5 Yu-An Chen,6 Yaa-Hui Dong5– 7 1Department of Pharmacy, Far Eastern Memorial Hospital, Banciao, New Taipei City, Taiwan; 2Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan; 3Department of Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan; 4Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan; 5Department of Pharmacy, College of Pharmaceutical Sciences, National Yang Ming Chiao Tung University, Taipei, Taiwan; 6Institute of Public Health, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan; 7Institute of Hospital and Health Care Administration, School of Medicine, National Yang Ming Chiao Tung University, Taipei, TaiwanCorrespondence: Yaa-Hui DongDepartment of Pharmacy, College of Pharmaceutical Sciences, National Yang Ming Chiao Tung University, 155, Sec 2, Linong Street, Taipei, 112, TaiwanTel +886-2-28267986Fax +886-2-28237929Email yaahuidong@gmail.comBackground: Several observational studies have found that statins may materially decrease the risk of chronic obstructive pulmonary disease (COPD) exacerbations. However, most of these studies used a prevalent user, non-user comparison approach, which may lead to overestimation of the clinical benefits of statins. We aimed to explore the risk of COPD exacerbations associated with statins with a new user, active comparison approach to address potential methodological concerns. We selected fibrates, another class of lipid-lowering agents, as the reference group because no evidence suggests that fibrates have an effect on COPD exacerbations.Methods: We identified patients with COPD who initiated statins or fibrates from a nationwide Taiwanese database. Patients were followed from cohort entry to the earliest of the following: hospitalization for COPD exacerbations, death, end of the data, or 180 days after cohort entry. Stratified Cox regression models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) of COPD exacerbations comparing statins with fibrates after variable-ratio propensity score (PS) matching and high-dimensional PS (hd-PS) matching, respectively.Results: We identified a total of 134,909 eligible patients (110,726 initiated statins; 24,183 initiated fibrates); 1979 experienced COPD exacerbations during follow-up. The HRs were 1.10 (95% CI, 0.96 to 1.26) after PS matching and 1.08 (95% CI, 0.94 to 1.24) after hd-PS matching. The results did not differ materially by type of statins and patient characteristic and did not change with longer follow-up durations.Conclusion: This large-scale, population-based cohort study did not show that use of statins was associated with a reduced risk of acute exacerbations in patients with COPD using state-of-the-art pharmacoepidemiologic approaches. The findings emphasize the importance of applying appropriate methodology in exploring statin effectiveness in real-world settings.Keywords: chronic obstructive pulmonary disease, statins, acute exacerbations, cohort study, new users, active comparison, high-dimensional propensity score |
| first_indexed | 2024-12-21T10:29:39Z |
| format | Article |
| id | doaj.art-c1ba2d25487746019dd0ff0e588d2354 |
| institution | Directory Open Access Journal |
| issn | 1178-2005 |
| language | English |
| last_indexed | 2024-12-21T10:29:39Z |
| publishDate | 2021-10-01 |
| publisher | Dove Medical Press |
| record_format | Article |
| series | International Journal of COPD |
| spelling | doaj.art-c1ba2d25487746019dd0ff0e588d23542022-12-21T19:07:14ZengDove Medical PressInternational Journal of COPD1178-20052021-10-01Volume 162721273369337Risk of COPD Exacerbations Associated with Statins versus Fibrates: A New User, Active Comparison, and High-Dimensional Propensity Score Matched Cohort StudySun SHChang CHZhan ZWChang WHChen YADong YHShu-Hui Sun,1 Chia-Hsuin Chang,2– 4 Zhe-Wei Zhan,5 Wen-Hsuan Chang,5 Yu-An Chen,6 Yaa-Hui Dong5– 7 1Department of Pharmacy, Far Eastern Memorial Hospital, Banciao, New Taipei City, Taiwan; 2Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan; 3Department of Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan; 4Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan; 5Department of Pharmacy, College of Pharmaceutical Sciences, National Yang Ming Chiao Tung University, Taipei, Taiwan; 6Institute of Public Health, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan; 7Institute of Hospital and Health Care Administration, School of Medicine, National Yang Ming Chiao Tung University, Taipei, TaiwanCorrespondence: Yaa-Hui DongDepartment of Pharmacy, College of Pharmaceutical Sciences, National Yang Ming Chiao Tung University, 155, Sec 2, Linong Street, Taipei, 112, TaiwanTel +886-2-28267986Fax +886-2-28237929Email yaahuidong@gmail.comBackground: Several observational studies have found that statins may materially decrease the risk of chronic obstructive pulmonary disease (COPD) exacerbations. However, most of these studies used a prevalent user, non-user comparison approach, which may lead to overestimation of the clinical benefits of statins. We aimed to explore the risk of COPD exacerbations associated with statins with a new user, active comparison approach to address potential methodological concerns. We selected fibrates, another class of lipid-lowering agents, as the reference group because no evidence suggests that fibrates have an effect on COPD exacerbations.Methods: We identified patients with COPD who initiated statins or fibrates from a nationwide Taiwanese database. Patients were followed from cohort entry to the earliest of the following: hospitalization for COPD exacerbations, death, end of the data, or 180 days after cohort entry. Stratified Cox regression models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) of COPD exacerbations comparing statins with fibrates after variable-ratio propensity score (PS) matching and high-dimensional PS (hd-PS) matching, respectively.Results: We identified a total of 134,909 eligible patients (110,726 initiated statins; 24,183 initiated fibrates); 1979 experienced COPD exacerbations during follow-up. The HRs were 1.10 (95% CI, 0.96 to 1.26) after PS matching and 1.08 (95% CI, 0.94 to 1.24) after hd-PS matching. The results did not differ materially by type of statins and patient characteristic and did not change with longer follow-up durations.Conclusion: This large-scale, population-based cohort study did not show that use of statins was associated with a reduced risk of acute exacerbations in patients with COPD using state-of-the-art pharmacoepidemiologic approaches. The findings emphasize the importance of applying appropriate methodology in exploring statin effectiveness in real-world settings.Keywords: chronic obstructive pulmonary disease, statins, acute exacerbations, cohort study, new users, active comparison, high-dimensional propensity scorehttps://www.dovepress.com/risk-of-copd-exacerbations-associated-with-statins-versus-fibrates-a-n-peer-reviewed-fulltext-article-COPDchronic obstructive pulmonary diseasestatinsacute exacerbationscohort studynew usersactive comparisonhigh-dimensional propensity score |
| spellingShingle | Sun SH Chang CH Zhan ZW Chang WH Chen YA Dong YH Risk of COPD Exacerbations Associated with Statins versus Fibrates: A New User, Active Comparison, and High-Dimensional Propensity Score Matched Cohort Study International Journal of COPD chronic obstructive pulmonary disease statins acute exacerbations cohort study new users active comparison high-dimensional propensity score |
| title | Risk of COPD Exacerbations Associated with Statins versus Fibrates: A New User, Active Comparison, and High-Dimensional Propensity Score Matched Cohort Study |
| title_full | Risk of COPD Exacerbations Associated with Statins versus Fibrates: A New User, Active Comparison, and High-Dimensional Propensity Score Matched Cohort Study |
| title_fullStr | Risk of COPD Exacerbations Associated with Statins versus Fibrates: A New User, Active Comparison, and High-Dimensional Propensity Score Matched Cohort Study |
| title_full_unstemmed | Risk of COPD Exacerbations Associated with Statins versus Fibrates: A New User, Active Comparison, and High-Dimensional Propensity Score Matched Cohort Study |
| title_short | Risk of COPD Exacerbations Associated with Statins versus Fibrates: A New User, Active Comparison, and High-Dimensional Propensity Score Matched Cohort Study |
| title_sort | risk of copd exacerbations associated with statins versus fibrates a new user active comparison and high dimensional propensity score matched cohort study |
| topic | chronic obstructive pulmonary disease statins acute exacerbations cohort study new users active comparison high-dimensional propensity score |
| url | https://www.dovepress.com/risk-of-copd-exacerbations-associated-with-statins-versus-fibrates-a-n-peer-reviewed-fulltext-article-COPD |
| work_keys_str_mv | AT sunsh riskofcopdexacerbationsassociatedwithstatinsversusfibratesanewuseractivecomparisonandhighdimensionalpropensityscorematchedcohortstudy AT changch riskofcopdexacerbationsassociatedwithstatinsversusfibratesanewuseractivecomparisonandhighdimensionalpropensityscorematchedcohortstudy AT zhanzw riskofcopdexacerbationsassociatedwithstatinsversusfibratesanewuseractivecomparisonandhighdimensionalpropensityscorematchedcohortstudy AT changwh riskofcopdexacerbationsassociatedwithstatinsversusfibratesanewuseractivecomparisonandhighdimensionalpropensityscorematchedcohortstudy AT chenya riskofcopdexacerbationsassociatedwithstatinsversusfibratesanewuseractivecomparisonandhighdimensionalpropensityscorematchedcohortstudy AT dongyh riskofcopdexacerbationsassociatedwithstatinsversusfibratesanewuseractivecomparisonandhighdimensionalpropensityscorematchedcohortstudy |