Statin Therapy Is Associated with Reduced Risk of Peptic Ulcer Disease in the Taiwanese Population.

Chun-Jung Lin,Min-Chuan Kao,Yu-An Chen,Chih-Ho Lai,Chia-Hung Kao,Hwai-Jeng Lin,Wei-Chih Liao,Mei-Zi Huang,Chun-Lung Feng,Cheng-Li Lin,Ying-Ju Lin

doi:10.3389/fphar.2017.00210

Abstract

Although statin use may affect the severity of chronic gastritis and gastric cancer, no data exists about the relationship between statin therapy and risk of peptic ulcer disease (PUD) in patients. We investigated the effect of statin use and the incidence of PUD from the Taiwan National Health Insurance Research Database (NHIRD). A total of 35,194 patients records for medical claims were enrolled. We performed a population-based case-control analysis to compare the incidence of PUD in patients who were prescribed statins and that in patients who were not. In the univariate logistic analysis, we found that statin was not significant risk of PUD. However, a multivariate model indicates that satin use was significantly associated with a reduced risk of PUD (adjusted odds ratio [aOR] = 0.87, 95% CI = 0.82–0.93, P < 0.001). The cumulative defined daily dose (DDD) was analyzed. Patients who prescribed fluvastatin ≥280 DDD, atorvastatin ≥200 DDD, and pravastatin ≥130 DDD dramatically decreased risk for PUD (aOR = 0.58, 0.67, and 0.71; 95% CI = 0.46–0.74, 0.57–0.78, and 0.56–0.91, respectively). Our results showed that statin therapy reduced the risk of PUD and this was associated with the high cumulative DDD of prescribed statins. This study reveals that active use of statins to be associated with decreased risk for PUD.

Highlights

Peptic ulcer disease (PUD) has been known can be caused by Helicobacter pylori infection and widespread use of nonsteroidal anti-inflammatory drugs (NSAIDs; Malfertheiner et al, 2009)
The National Health Insurance Research Database (NHIRD) contains medical information, including data on inpatient and outpatient care facilities, drug prescriptions, insurant sex and date of birth, date of visit or hospitalization, and diagnoses coded in the format of the International Classification of Disease, 9th Revision, Clinical Modification (ICD-9-CM) that has been described in our previous studies
In comparison with non-statin users, patients with a cumulative defined daily dose (DDD) of fluvastatin ≥280 had the lowest risk of peptic ulcer disease (PUD), followed by patients with a cumulative DDD of atorvastatin ≥200, patients with a cumulative DDD of rosuvastatin ≥230, patients with a cumulative DDD of pravastatin ≥130, and patients with a cumulative DDD of simvastatin ≥160

Summary

Introduction

Peptic ulcer disease (PUD) has been known can be caused by Helicobacter pylori infection and widespread use of nonsteroidal anti-inflammatory drugs (NSAIDs; Malfertheiner et al, 2009). Previous studies have reported that combination treatments, including triple therapies (consisting of a proton-pump inhibitor, amoxicillin, and clarithromycin) prescribed along with statins, accelerate H. pylori clearance and ameliorate ulcer development (Tariq et al, 2007; Yamato et al, 2007; Nseir et al, 2012). In addition to cholesterol lowering effects, statins have anti-inflammatory properties including modulation of immune responses, regulation of MHC expression, mucosal proliferation, and secretory activity (Kwak et al, 2000; WeitzSchmidt et al, 2001). The additional benefits of statins included gastroprotective effects and attenuation of peptic ulcer development (Tariq et al, 2007; Heeba et al, 2009). The clinical relevance of statins on gastrointestinal disorders require further investigation

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