Statin use and all-cause mortality in people living with HIV: a systematic review and meta-analysis

Olalekan A Uthman; Chidozie Nduka; Samuel I Watson; Edward J Mills; Andre P Kengne; Shabbar S Jaffar; Aileen Clarke; Tahereh Moradi; Anna-Mia Ekström; Richard Lilford

doi:10.1186/s12879-018-3162-1

Statin use and all-cause mortality in people living with HIV: a systematic review and meta-analysis

Olalekan A Uthman, Chidozie Nduka, Samuel I Watson, Edward J Mills, Andre P Kengne, Shabbar S Jaffar, Aileen Clarke, Tahereh Moradi, Anna-Mia Ekström, Richard Lilford

Applied Health Research

Research output: Contribution to journal › Article › peer-review

15 Citations (Scopus)

Abstract

BACKGROUND: It is unknown whether statin use among people living with HIV results in a reduction in all-cause mortality. We aimed to evaluate the effect of statin use on all-cause mortality among people living with HIV.

METHODS: We conducted comprehensive literature searches of Medline, Embase, CINAHL, the Cochrane Library, and cross-references up to April 2018. We included randomised, quasi-randomised trials and prospective cohort studies that examined the association between statin use and cardio-protective and mortality outcomes among people living with HIV. Two reviewers independently abstracted the data. Hazard ratios (HRs) were pooled using empirical Bayesian random-effect meta-analysis. A number of sensitivity analyses were conducted.

RESULTS: We included seven studies with a total of 35,708 participants. The percentage of participants on statins across the studies ranged from 8 to 35%. Where reported, the percentage of participants with hypertension ranged from 14 to 35% and 7 to 10% had been diagnosed with diabetes mellitus. Statin use was associated with a 33% reduction in all-cause mortality (pooled HR = 0.67, 95% Credible Interval 0.39 to 0.96). The probability that statin use conferred a moderate mortality benefit (i.e. decreased risk of mortality of at least 25%, HR ≤ 0.75) was 71.5%. Down-weighting and excluding the lower quality studies resulted in a more conservative estimate of the pooled HR.

CONCLUSION: Statin use appears to confer moderate mortality benefits in people living with HIV.

Original language	English
Pages (from-to)	258
Journal	BMC Infectious Diseases
Volume	18
Issue number	1
DOIs	https://doi.org/10.1186/s12879-018-3162-1
Publication status	Published - 5 Jun 2018

Keywords

Cardiovascular Diseases/complications
Cause of Death
HIV Infections/complications
Humans
Hydroxymethylglutaryl-CoA Reductase Inhibitors/therapeutic use
Proportional Hazards Models
Risk Assessment

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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10.1186/s12879-018-3162-1

Cite this

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title = "Statin use and all-cause mortality in people living with HIV: a systematic review and meta-analysis",

abstract = "BACKGROUND: It is unknown whether statin use among people living with HIV results in a reduction in all-cause mortality. We aimed to evaluate the effect of statin use on all-cause mortality among people living with HIV.METHODS: We conducted comprehensive literature searches of Medline, Embase, CINAHL, the Cochrane Library, and cross-references up to April 2018. We included randomised, quasi-randomised trials and prospective cohort studies that examined the association between statin use and cardio-protective and mortality outcomes among people living with HIV. Two reviewers independently abstracted the data. Hazard ratios (HRs) were pooled using empirical Bayesian random-effect meta-analysis. A number of sensitivity analyses were conducted.RESULTS: We included seven studies with a total of 35,708 participants. The percentage of participants on statins across the studies ranged from 8 to 35%. Where reported, the percentage of participants with hypertension ranged from 14 to 35% and 7 to 10% had been diagnosed with diabetes mellitus. Statin use was associated with a 33% reduction in all-cause mortality (pooled HR = 0.67, 95% Credible Interval 0.39 to 0.96). The probability that statin use conferred a moderate mortality benefit (i.e. decreased risk of mortality of at least 25%, HR ≤ 0.75) was 71.5%. Down-weighting and excluding the lower quality studies resulted in a more conservative estimate of the pooled HR.CONCLUSION: Statin use appears to confer moderate mortality benefits in people living with HIV.",

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author = "Uthman, {Olalekan A} and Chidozie Nduka and Watson, {Samuel I} and Mills, {Edward J} and Kengne, {Andre P} and Jaffar, {Shabbar S} and Aileen Clarke and Tahereh Moradi and Anna-Mia Ekstr{\"o}m and Richard Lilford",

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T2 - a systematic review and meta-analysis

AU - Uthman, Olalekan A

AU - Nduka, Chidozie

AU - Watson, Samuel I

AU - Mills, Edward J

AU - Kengne, Andre P

AU - Jaffar, Shabbar S

AU - Clarke, Aileen

AU - Moradi, Tahereh

AU - Ekström, Anna-Mia

AU - Lilford, Richard

PY - 2018/6/5

Y1 - 2018/6/5

N2 - BACKGROUND: It is unknown whether statin use among people living with HIV results in a reduction in all-cause mortality. We aimed to evaluate the effect of statin use on all-cause mortality among people living with HIV.METHODS: We conducted comprehensive literature searches of Medline, Embase, CINAHL, the Cochrane Library, and cross-references up to April 2018. We included randomised, quasi-randomised trials and prospective cohort studies that examined the association between statin use and cardio-protective and mortality outcomes among people living with HIV. Two reviewers independently abstracted the data. Hazard ratios (HRs) were pooled using empirical Bayesian random-effect meta-analysis. A number of sensitivity analyses were conducted.RESULTS: We included seven studies with a total of 35,708 participants. The percentage of participants on statins across the studies ranged from 8 to 35%. Where reported, the percentage of participants with hypertension ranged from 14 to 35% and 7 to 10% had been diagnosed with diabetes mellitus. Statin use was associated with a 33% reduction in all-cause mortality (pooled HR = 0.67, 95% Credible Interval 0.39 to 0.96). The probability that statin use conferred a moderate mortality benefit (i.e. decreased risk of mortality of at least 25%, HR ≤ 0.75) was 71.5%. Down-weighting and excluding the lower quality studies resulted in a more conservative estimate of the pooled HR.CONCLUSION: Statin use appears to confer moderate mortality benefits in people living with HIV.

AB - BACKGROUND: It is unknown whether statin use among people living with HIV results in a reduction in all-cause mortality. We aimed to evaluate the effect of statin use on all-cause mortality among people living with HIV.METHODS: We conducted comprehensive literature searches of Medline, Embase, CINAHL, the Cochrane Library, and cross-references up to April 2018. We included randomised, quasi-randomised trials and prospective cohort studies that examined the association between statin use and cardio-protective and mortality outcomes among people living with HIV. Two reviewers independently abstracted the data. Hazard ratios (HRs) were pooled using empirical Bayesian random-effect meta-analysis. A number of sensitivity analyses were conducted.RESULTS: We included seven studies with a total of 35,708 participants. The percentage of participants on statins across the studies ranged from 8 to 35%. Where reported, the percentage of participants with hypertension ranged from 14 to 35% and 7 to 10% had been diagnosed with diabetes mellitus. Statin use was associated with a 33% reduction in all-cause mortality (pooled HR = 0.67, 95% Credible Interval 0.39 to 0.96). The probability that statin use conferred a moderate mortality benefit (i.e. decreased risk of mortality of at least 25%, HR ≤ 0.75) was 71.5%. Down-weighting and excluding the lower quality studies resulted in a more conservative estimate of the pooled HR.CONCLUSION: Statin use appears to confer moderate mortality benefits in people living with HIV.

KW - Cardiovascular Diseases/complications

KW - Cause of Death

KW - HIV Infections/complications

KW - Humans

KW - Hydroxymethylglutaryl-CoA Reductase Inhibitors/therapeutic use

KW - Proportional Hazards Models

KW - Risk Assessment

U2 - 10.1186/s12879-018-3162-1

DO - 10.1186/s12879-018-3162-1

M3 - Article

C2 - 29866059

SN - 1471-2334

VL - 18

SP - 258

JO - BMC Infectious Diseases

JF - BMC Infectious Diseases

IS - 1

ER -

Statin use and all-cause mortality in people living with HIV: a systematic review and meta-analysis

Abstract

Keywords

UN SDGs

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