The protective effect of statins against pressure ulcers in stroke patients: A propensity-score matched study based on a real-world database

Abstract

Background and aims: Limited information is available regarding the association between statins and pressure ulcers. The purpose of this study is to evaluate the beneficial effects of statins on pressure ulcers in stroke patients.

Methods: Using the claims data of Taiwan's National Health Insurance, we conducted a retrospective cohort study and identified new-onset stroke patients in 2000-2004. The propensity-score matching procedure was used to select eligible stroke patients with (n = 49,919) and without (n = 49,919) the use of statins. These two groups were followed until the end of 2009 to track the occurrence of pressure ulcers. Multivariate Cox proportional hazard models were conducted to calculate adjusted hazard rations (HRs) and 95% confidence intervals (CIs) of pressure ulcer associated with the use of statins.

Results: Stroke patients who used statins had a reduced risk of pressure ulcers during the follow-up period (HR 0.74, 95% CI 0.71-0.78). The association between statin use and a reduced risk of poststroke pressure ulcers was significant in men (HR 0.73, 95% CI 0.68-0.78), women (HR 0.75, 95% CI 0.71-0.80), and people aged more than 50 years. Use of lovastatin, pravastatin, rosuvastatin, atrovastatin, fluvastatin, and simvastatin was associated with reduced poststroke pressure ulcers. There was a dose-dependent decrease in the frequency of pressure ulcers with increasing quantities of statins used, from 1 prescription to ≥3 prescriptions.

Conclusion: We raised the possibility that use of statins was associated with reduced risk of pressure ulcers in stroke patients. However, the potential beneficial effect associated with statins requires further validation using randomized clinical trials.

Keywords: Insurance; Pressure ulcer; Risk; Statins; Stroke.