Epidemiology and Health

Original Articles

The risk of stroke according to statin medication compliance in older people with chronic periodontitis: an analysis using the Korea National Health Insurance Service-Senior Cohort Database: Seon-Rye Kim, Minkook Son, Yu-Rin Kim; Epidemiol Health. 2022;44:e2022055. Published online July 5, 2022; DOI: https://doi.org/10.4178/epih.e2022055

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Abstract Summary PDF Supplementary Material

Abstract

OBJECTIVES
We investigated the risk of stroke according to statin medication compliance in older people with chronic periodontitis.

METHODS

Chronic periodontitis patients were extracted from the National Health Insurance Service-Senior Cohort Database from 2002 to 2014. Among 255,056 chronic periodontitis patients, 41,412 patients with statin prescriptions for 28 days or more were included. The study population was divided into the top 25% of medication compliance group (TSG) and the lower 25% of medication compliance group (BSG). After 1:1 propensity score matching was performed, the final number of patients in the BSG and TSG was 6,172 each. To analyze the risk of stroke, a Cox proportional hazard model was performed to calculate hazard ratios (HRs) and 95% confidence intervals (95% CIs) after adjusting for age, sex, income level, hypertension, diabetes, and Charlson comorbidity index.

RESULTS

In the Kaplan-Meier curve, the disease-free probability was prominently lower in the BSG than in the TSG (p for log-rank= 0.001). The HR in the multivariable-adjusted model for stroke occurrence in the TSG compared to the BSG was 0.79 (95% CI, 0.67 to 0.92; p= 0.002). Subgroup analyses showed significant associations between compliance to statin medication and stroke, especially in female, people 85 years or older, and patients with comorbidities.

CONCLUSIONS

Increasing compliance to statins may reduce stroke risk in older adults with chronic periodontitis. Therefore, in order to increase medication compliance among older people with chronic periodontitis, it is necessary for medical staff to make efforts to provide effective medication guidance.

Summary

Korean summary
만성치주질환을 가진 노인에서 스타틴 복용순응도가 낮은 그룹에 비해 높은 그룹이 뇌졸증 발생위험이 낮았다. 특히 여성과 후기 노인 (85세 이상), 동반 질환을 가진 그룹에서 유의한 차이가 있었다. 따라서 스타틴 복용 순응도를 증대시키기 위한 의료진의 노력이 필요할 것이다.

Key Message
The stroke risk of chronic periodontal disease patients was related to statin medication compliance, and the effect of stroke risk was different in women, the elderly, and comorbidities.

Citations

Citations to this article as recorded by

Association between statin compliance and risk of dementia among patients with chronic periodontitis
Yu‐Rin Kim, Minkook Son, Seon‐Rye Kim
Oral Diseases.2023;[Epub] CrossRef
Impact of statin treatment on cardiovascular events in patients with retinal vein occlusion: a nested case-control study in Korea
Joonsang Yoo, Joo Youn Shin, Jimin Jeon, Jinkwon Kim
Epidemiology and Health.2023; 45: e2023035. CrossRef

Effects of early medication treatment and metformin use for cancer prevention in diabetes patients: a nationwide sample cohort study in Korea using extended landmark time analysis: Hwa Jeong Seo, Hyun Sook Oh; Epidemiol Health. 2021;43:e2021103. Published online December 17, 2021; DOI: https://doi.org/10.4178/epih.e2021103

8,092 View
188 Download
5 Web of Science
3 Crossref

Abstract Summary PDF Supplementary Material

Abstract

OBJECTIVES
This study investigated the effectiveness of early medication treatment and metformin use for cancer prevention in type 2 diabetes patients.

METHODS

Population-based cohort data were used from the Korean National Health Insurance Service-National Sample Cohort database (KNHIS-NSC) for 2002-2013. Patient-specific medication prescription status was defined by the landmark time (LMT; a fixed time after cohort entry), considering both pre- and post-LMT prescriptions to control methodological biases in observational research. The LMT was set to 2 years. Logistic regression analysis with multivariable adjustment was conducted to analyze cancer incidence by patient-specific medication prescription status.

RESULTS

Only 33.4% of the subjects were prescribed medication early (before the LMT) with compliance. Cancer incidence in individuals with early prescription and compliance was 25% lower (odds ratio [OR], 0.75; 95% confidence interval [CI], 0.67 to 0.84) than in those without. As early-prescribed medications, metformin monotherapy and metformin combination therapy were associated with 34% (OR, 0.66; 95% CI, 0.51 to 0.83) and 25% (OR, 0.75; 95% CI, 0.64 to 0.88) lower cancer risk than non-use, respectively. Patients who were prescribed late (post-LMT) but did not comply with the prescription had a 24% (OR, 1.24; 95% CI, 0.97 to 1.58) higher cancer incidence than non-users. Among patients who started monotherapy early without changes throughout the entire follow-up period, those who started on metformin had a 37% (OR, 0.63; 95% CI, 0.41 to 0.99) lower risk of cancer than non-metformin users.

CONCLUSIONS

Doctors must prescribe antidiabetic medication early, and patient compliance is required, regardless of the prescription time, to prevent cancer. Metformin monotherapy or combination therapy is recommended as an early prescription.

Summary

Korean summary
당뇨 환자는 암 발병 위험이 높으며 암은 주요 사망 원인이다. 당뇨환자의 암발생 예방을 위한 관리로서, 당뇨병 진단 후 약물 치료 시기에 대한 연구는 부족하다. 또한, 전 세계적으로 가장 흔히 처방되는 당뇨병 치료제인 메트포민은 암 예방 효과가 있다고 알려져 왔으나 관측연구에서 발생하는 선택 편향의 문제가 제기되었고, 최근 일부 연구에서 기존의 암 예방 효과와 상충되는 결과가 나오고 있어 논쟁이 이어지고 있다. 본 연구는 선택 편향을 통제한 코호트 연구에서 조기 약물 치료와 메트포민 사용이 당뇨환자의 암 예방에 효과적임을 밝혔다. 따라서 의사들은 처음 당뇨 진단을 받은 환자에게 조기에 약물 처방을 하고, 환자들은 처방에 잘 따라야 한다. 조기 처방 약물로서 메트포민이 권장된다.

Key Message
Diabetic patients have a high risk of developing cancer, and cancer is the leading cause of death. There are few studies on the timing of medication treatment after diagnosis of diabetes. In addition, metformin, the most commonly prescribed diabetes treatment worldwide, is known to have cancer-preventive effects, but the problem of selection bias that occurs in observational studies has been raised, and some studies have recently been contradicting the existing cancer-preventing effects of metformin. This study, in a cohort study controlled for selection bias, demonstrated that early medication treatment and metformin use were effective in preventing cancer in diabetic patients.

Citations

Citations to this article as recorded by

Association between metformin use and the risk of developing open-angle glaucoma among patients with diabetes: a retrospective cohort study and meta-analysis
Hong Kyu Kim, Wanhyung Lee, Ik Hee Ryu, Jin Kuk Kim, Hyungsu Kim, Tae Keun Yoo
International Ophthalmology.2024;[Epub] CrossRef
Metformin and HER2-positive breast cancer: Mechanisms and therapeutic implications
Sara S Bashraheel, Hadeel Kheraldine, Sarah Khalaf, Ala-Eddin Al Moustafa
Biomedicine & Pharmacotherapy.2023; 162: 114676. CrossRef
Effects of millimeter-wave for preventing joint stiffness in the immobilized knee rat model
Xiao-ping Shui, Feng Ye, Chun-ying Li, Xin Zhang, Min-jia Wang, Bin Li, Ke Chen, Ying-ying Liao
The Knee.2023; 42: 236. CrossRef

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