Dataset Information

Association between statin use and herpes zoster: systematic review and meta-analysis.

ABSTRACT:

Objective

Statins are commonly prescribed worldwide. In addition to being potent lipid-lowering agents, statins have immunomodulating properties that may increase the risk of varicella zoster virus reactivation. This adverse effect may have substantial public health implications.

Design

We performed a meta-analysis of observational studies to assess the association between statin use and the risk of herpes zoster infection. We searched PubMed, Embase, Web of Science and Cochrane databases to identify studies published from 1980 to 2018. The multivariate-adjusted ORs were pooled using random-effect models, and subgroup and sensitivity analyses were performed to examine the source of heterogeneity.

Result

Six studies were analysed, with a total of more than two million participants. We determined if the use of statins might increase the risk of infection of herpes zoster (OR 1.18, 95% CI 1.11 to 1. 25). We detected significant heterogeneity (I²=91.2%; p<0.000), and determined that the heterogeneity arises from regional differences.

Conclusion

The use of statins may increase the risk of herpes zoster infection. Because the studies included are limited and there may be potential bias, further studies are warranted.

SUBMITTER: Fan L

PROVIDER: S-EPMC6398719 | biostudies-literature | 2019 Feb

REPOSITORIES: biostudies-literature

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Publications

Association between statin use and herpes zoster: systematic review and meta-analysis.

Fan Lailai L Wang Yangyang Y Liu Xiang X Guan Xueqiang X

BMJ open 20190213 2

<h4>Objective</h4>Statins are commonly prescribed worldwide. In addition to being potent lipid-lowering agents, statins have immunomodulating properties that may increase the risk of varicella zoster virus reactivation. This adverse effect may have substantial public health implications.<h4>Design</h4>We performed a meta-analysis of observational studies to assess the association between statin use and the risk of herpes zoster infection. We searched PubMed, Embase, Web of Science and Cochrane d ...[more]

PMID: 30765397

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Project description:The epidemiology and burden of Herpes Zoster (HZ) are largely unknown, and there are no recent reviews summarizing the available evidence from the Latin America and Caribbean (LAC) region. We conducted a systematic review and meta-analysis to characterize the epidemiology and burden of HZ in LAC. Bibliographic databases and grey literature sources were consulted to find studies published (January 2000 -February 2020) with epidemiological endpoints: cumulative incidence and incidence density (HZ cases per 100,000 person-years), prevalence, case-fatality rates, HZ mortality, hospitalization rates, and rates of each HZ complication. Twenty-six studies were included with most studies coming from Brazil. No studies reported the incidence of HZ in the general population. In population at higher risk, the cumulative incidence ranged from 318-3,423 cases of HZ per 100,000 persons per year of follow-up. The incidence density was 6.4-36.5 cases per 1,000 person-years. Age was identified as a major risk factor towards HZ incidence which increase significantly in people >50 years of age. Hospitalization rates ranged from 3%-35.7%. The in-hospital HZ mortality rate ranged from 0%-36%. Overall, HZ mortality rates were found to be higher in females across all age groups and countries. The incidence of HZ complications (such as post-herpetic neuralgia, ophthalmic herpes zoster, and Ramsay Hunt syndrome) was higher in the immunosuppressed compared to the immunocompetent population. Acyclovir was the most frequently used therapy. Epidemiological data from Ministry of Health databases (Argentina, Brazil, Colombia, Chile y Mexico) and Institute for Health Metrics and Evaluation's Global Burden of Disease project reported stable rates of hospitalizations and deaths over the last 10 years. High-risk groups for HZ impose a considerable burden in LAC. They could benefit from directed healthcare initiatives, including adult immunization, to prevent HZ occurrence and its complications.

Project description:BACKGROUND:The role of statins in patients with heart failure (HF) of different levels of left ventricular ejection fraction (LVEF) remains unclear especially in the light of the absence of prospective data from randomized controlled trials (RCTs) in non-ischemic HF, and taking into account potential statins' prosarcopenic effects. We assessed the association of statin use with clinical outcomes in patients with HF. METHODS:We searched PubMed, EMBASE, Scopus, Google Scholar and Cochrane Central until August 2018 for RCTs and prospective cohorts comparing clinical outcomes with statin vs non-statin use in patients with HF at different LVEF levels. We followed the guidelines of the 2009 PRISMA statement for reporting and applied independent extraction by multiple observers. Meta-analyses of hazard ratios (HRs) of effects of statins on clinical outcomes used generic inverse variance method and random model effects. Clinical outcomes were all-cause mortality, cardiovascular (CV) mortality and CV hospitalization. RESULTS:Finally we included 17 studies (n?=?88,100; 2 RCTs and 15 cohorts) comparing statin vs non-statin users (mean follow-up 36?months). Compared with non-statin use, statin use was associated with lower risk of all-cause mortality (HR 0.77, 95% confidence interval [CI], 0.72-0.83, P?<?0.0001, I2 =?63%), CV mortality (HR 0.82, 95% CI: 0.76-0.88, P?<?0.0001, I2 =?63%), and CV hospitalization (HR 0.78, 95% CI: 0.69-0.89, P?=?0.0003, I2 =?36%). All-cause mortality was reduced on statin therapy in HF with both EF?<?40% and???40% (HR: 0.77, 95% Cl: 0.68-0.86, P?<?0.00001, and HR 0.75, 95% CI: 0.69-0.82, P?<?0.00001, respectively). Similarly, CV mortality (HR 0.86, 95% CI: 0.79-0.93, P?=?0.0003, and HR 0.83, 95% CI: 0.77-0.90, P?<?0.00001, respectively), and CV hospitalizations (HR 0.80 95% CI: 0.64-0.99, P?=?0.04 and HR 0.76 95% CI: 0.61-0.93, P?=?0.009, respectively) were reduced in these EF subgroups. Significant effects on all clinical outcomes were also found in cohort studies' analyses; the effect was also larger and significant for lipophilic than hydrophilic statins. CONCLUSIONS:In conclusion, statins may have a beneficial effect on CV outcomes irrespective of HF etiology and LVEF level. Lipophilic statins seem to be much more favorable for patients with heart failure.

Dataset Information

Association between statin use and herpes zoster: systematic review and meta-analysis.

Objective

Design

Result

Conclusion

Publications

Association between statin use and herpes zoster: systematic review and meta-analysis.

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