Abstract
High temperature increases all-cause mortality. Thermoregulatory ability is impaired in persons with elevated serum cholesterol, but can be improved by the administration of statins, even in the short-term. We investigated whether the impact of high temperature (≥24 °C) on all-cause mortality among socioeconomically disadvantaged adults with a current or past indication for a statin is attenuated by current use of a statin with temperature dependence, by using claims data from five US Medicaid programs supplemented with Medicare claims for dual-enrollees and meteorological data from 1999–2010. We identified 3,508,948 persons (3,181,752 person-years) in a 1:1 propensity score-matched cohort. The incidence rate of all-cause mortality (deaths per 1,000 person-years) was 21.9 (95% confidence interval [CI]: 21.6 to 22.3) in current statin users and 30.1 (95% CI: 30.2 to 30.6) in former users. The adjusted odds ratios of mortality for current vs. former statin use were statistically significantly lower than 1.0, suggesting a protective effect of current statin use, on days with high temperature, with either daily average temperature or daily maximum temperature, and declined as daily average temperature increased from 29 °C and daily maximum temperature increased from 34 °C. These results were robust to the adjustment for daily relative humidity.
Highlights
We hypothesized that statins might attenuate the association between elevated ambient temperature and all-cause mortality in socioeconomically disadvantaged populations, such as those enrolled in the United States Medicaid program, with temperature dependence
We identified 4,048,019 current statin users and 1,754,486 former statin users who met inclusion and exclusion criteria
The interaction terms of current statin use and temperature, the main parameters of interest, were statistically significant: p = 0.0001 with daily average temperature, p = 0.0003 with daily average temperature squared; p = 0.009 with daily maximum temperature, and p = 0.016 with daily maximum temperature squared (Table 3). With both daily average temperature and daily maximum temperature, the odds ratios declined as daily average temperature increased from 29 °C and daily maximum temperature increased from 34 °C (Fig. 3)
Summary
Humans’ ability to thermoregulate in response to high ambient temperatures depends largely on our ability to increase cutaneous blood flow in part through endothelial vasorelaxation[6,7] This ability is impaired in persons with advanced age[8] and those with elevated serum cholesterol[9], it is improved by short-term administration of statins through mechanisms that appear to be independent of statins’ effects on lipids[10]. Other potentially thermo-protective mechanisms of statins include vasoprotection[12], endothelial function improvement[13,14], and atherosclerotic plaque stabilization[13] Given these effects, we hypothesized that statins might attenuate the association between elevated ambient temperature and all-cause mortality in socioeconomically disadvantaged populations, such as those enrolled in the United States Medicaid program, with temperature dependence
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