Background: Atherosclerosis and sepsis share several pathophysiological similarities, including immune dysregulation, increased thrombogenesis, and systemic inflammation. The relation between statins and risk of sepsi...Background: Atherosclerosis and sepsis share several pathophysiological similarities, including immune dysregulation, increased thrombogenesis, and systemic inflammation. The relation between statins and risk of sepsis in patients with atherosclerosis is unknown. Methods: We did a population-based cohort analysis through linked administrative databases in Ontario, Canada, with accrual from 1997 to 2002. We identified 141 487 patients older than 65 years who had been hospitalised for an acute coronary syndrome, ischaemic stroke, or revascularisation, who survived for at least 3 months after discharge. 46 662(33% ) were prescribed a statin within 90 days of discharge, 94 825(67% ) were not. Propensity-based matching, which accounted for each individual s likelihood of receiving a statin, yielded a cohort of 69 168 patients, of whom half(34 584) received a statin and half(34 584) did not. Findings: Incidence of sepsis was lower in patients receiving statins than in controls(71.2 vs 88.0 events per 10 000 person-years; hazard ratio [HR] 0.81; 95% CI 0.72-0.91). Adjustment for demographic characteristics, sepsis risk factors, comorbidities, and health-care use gave similar results(HR 0.81; 95% CI 0.72-0.90). The protective association between statins and sepsis persisted in high-risk subgroups,including patients with diabetes mellitus, chronic renal failure, or a history of infections. Significant reductions in severe sepsis(HR 0.83; 95% CI 0.70-0.97) and fatal sepsis(0.75; 0.61-0.93) were also observed. No benefit was noted with non-statin lipid-lowering agents(0.95; 0.75-1.22). Implications: Use of statins in patients with atherosclerosis is associated with a reduced risk of subsequent sepsis. Randomised trials of statins for prevention of sepsis are warranted.展开更多
Whether angiotensin-converting enzyme(ACE) inhibitors are interchangeable and equally efficacious after acute myocardial infarction(AMI) is controversial. We assessed whether ramipril was superior to other ACE inhibit...Whether angiotensin-converting enzyme(ACE) inhibitors are interchangeable and equally efficacious after acute myocardial infarction(AMI) is controversial. We assessed whether ramipril was superior to other ACE inhibitors after AMI as suggested by a previously published study. We performed a retrospective cohort study using linked administrative databases on >1.4 million elderly residents in the province of Ontario who were admitted to the hospital for AMI, survived ≥30 days after discharge, and were initiated on an ACE inhibitor after AMI and remained on the same ACE inhibitor from April 1, 1997 to March 31, 2000. We followed patients for 2 years and measured readmission for AMI or mortality, together or alone. Our cohort included 5,408 elderly patients. Compared with patients on enalapril, there was no significant difference for the combined end points of readmission for AMI or mortality across users of ramipril(adjusted hazard ratio 0.95, 95%confidence interval 0.79 to 1.15), lisinopril(adjusted hazard ratio 1.02, 95%confidence interval 0.84 to 1.25), or other ACE inhibitors(adjusted hazard ratio 1.08,95%confidence interval 0.88, 1.32). In conclusion, the findings of this study support a class effect among ACE inhibitors in treatment after AMI.展开更多
文摘Background: Atherosclerosis and sepsis share several pathophysiological similarities, including immune dysregulation, increased thrombogenesis, and systemic inflammation. The relation between statins and risk of sepsis in patients with atherosclerosis is unknown. Methods: We did a population-based cohort analysis through linked administrative databases in Ontario, Canada, with accrual from 1997 to 2002. We identified 141 487 patients older than 65 years who had been hospitalised for an acute coronary syndrome, ischaemic stroke, or revascularisation, who survived for at least 3 months after discharge. 46 662(33% ) were prescribed a statin within 90 days of discharge, 94 825(67% ) were not. Propensity-based matching, which accounted for each individual s likelihood of receiving a statin, yielded a cohort of 69 168 patients, of whom half(34 584) received a statin and half(34 584) did not. Findings: Incidence of sepsis was lower in patients receiving statins than in controls(71.2 vs 88.0 events per 10 000 person-years; hazard ratio [HR] 0.81; 95% CI 0.72-0.91). Adjustment for demographic characteristics, sepsis risk factors, comorbidities, and health-care use gave similar results(HR 0.81; 95% CI 0.72-0.90). The protective association between statins and sepsis persisted in high-risk subgroups,including patients with diabetes mellitus, chronic renal failure, or a history of infections. Significant reductions in severe sepsis(HR 0.83; 95% CI 0.70-0.97) and fatal sepsis(0.75; 0.61-0.93) were also observed. No benefit was noted with non-statin lipid-lowering agents(0.95; 0.75-1.22). Implications: Use of statins in patients with atherosclerosis is associated with a reduced risk of subsequent sepsis. Randomised trials of statins for prevention of sepsis are warranted.
文摘Whether angiotensin-converting enzyme(ACE) inhibitors are interchangeable and equally efficacious after acute myocardial infarction(AMI) is controversial. We assessed whether ramipril was superior to other ACE inhibitors after AMI as suggested by a previously published study. We performed a retrospective cohort study using linked administrative databases on >1.4 million elderly residents in the province of Ontario who were admitted to the hospital for AMI, survived ≥30 days after discharge, and were initiated on an ACE inhibitor after AMI and remained on the same ACE inhibitor from April 1, 1997 to March 31, 2000. We followed patients for 2 years and measured readmission for AMI or mortality, together or alone. Our cohort included 5,408 elderly patients. Compared with patients on enalapril, there was no significant difference for the combined end points of readmission for AMI or mortality across users of ramipril(adjusted hazard ratio 0.95, 95%confidence interval 0.79 to 1.15), lisinopril(adjusted hazard ratio 1.02, 95%confidence interval 0.84 to 1.25), or other ACE inhibitors(adjusted hazard ratio 1.08,95%confidence interval 0.88, 1.32). In conclusion, the findings of this study support a class effect among ACE inhibitors in treatment after AMI.
