Statins and the risk of herpes zoster: A population-based cohort study

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http://cid.oxfordjournals.org/content/early/2013/12/02/cid.cit745.short?rss=1

1. Tony Antoniou1,2,3,4,
2. Hong Zheng4,
3. Samantha Singh4,
4. David N. Juurlink3,4,5,
5. Muhammad M. Mamdani2,3,4,6,7, and
6. Tara Gomes2,3,4,6

+ Author Affiliations

1. ¹Department of Family and Community Medicine, St Michael's Hospital
2. ²Keenan Research Centre of the Li Ka Shing Knowledge Institute, St Michael's Hospital
3. ³University of Toronto
4. ⁴Institute for Clinical Evaluative Sciences
5. ⁵Sunnybrook Research Institute
6. ⁶Applied Health Research Centre, St Michael's Hospital, Toronto, Ontario, Canada
7. ⁷King Saud University, Riyadh, Saudi Arabia

1. Correspondence: Tony Antoniou, PhD, 410 Sherbourne St, 4th Floor, Toronto, ON M4X 1K2, Canada (tantoniou@smh.ca).

Abstract

Background.  Statins are widely used lipid-lowering drugs with immunomodulatory properties that may favor reactivation of latent varicella-zoster virus infection. However, whether statins increase the risk of herpes zoster is unknown.

Methods. We conducted a population-based retrospective cohort study of Ontario residents aged ≥66 years between 1 April 1997 and 31 March 2010 to examine the association between statin use and incidence of herpes zoster. We used propensity score matching to ensure similarity between users and nonusers of statins, and Cox proportional hazard models to assess differences in outcomes between study groups. To test the specificity of our findings, we examined the association between statin exposure and knee arthroplasty.

Results. During the 13-year study period, we matched 494 651 individuals treated with a statin to an equal number of untreated individuals. In the main analysis, the rate of herpes zoster was higher among users of statins relative to nonusers of these drugs (13.25 vs 11.71 per 1000 person-years, respectively; hazard ratio [HR], 1.13; 95% confidence interval [CI], 1.10–1.17). The attributable fraction of exposed individuals was 11.6%. In a prespecified analysis, we found a similar risk of herpes zoster among statin users in the subgroup of patients with diabetes (HR, 1.18; 95% CI, 1.09–1.27). As expected, we found no association between statin use and knee arthroplasty (HR, 1.04; 95% CI, .99–1.09).

Conclusions. Among older patients, treatment with statins is associated with a small but significantly increased risk of herpes zoster.