Korean J Intern Med.  2020 Sep;35(5):1220-1228. 10.3904/kjim.2019.020.

Mediation effect of herpes zoster derived by statin use on cardiovascular disease risk

Affiliations
  • 1Departments of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
  • 2Departments of Clinical Epidemiology and Biostatistics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
  • 3Department of Health Policy and Management, Seoul National University College of Medicine, Seoul, Korea
  • 4Division of Infectious Diseases, Department of Internal Medicine, Chung- Ang University Hospital, Seoul, Korea
  • 5Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
  • 6Department of Cardiology, Ulsan University Hospital, Ulsan, Korea
  • 7Department of Cardiology, Dong-A University College of Medicine, Busan, Korea

Abstract

Background/Aims
Although statins are widely used to reduce the risk of cardiovascular disease (CVD) including stroke and myocardial infarction (MI), it is reported that statin use increases the incidence of herpes zoster (HZ) that is associated with increased risk of CVD. So, we evaluated the mediation effect of HZ caused by statin use on CVD.
Methods
We analyzed a prospective cohort from the National Health Insurance Service-database of South Korea. All individuals received a medical check-up and were followed-up from 2002 to 2013.
Results
A total of 275,382 individuals > 40 years old were followed up for 11 years from 2003. Of these, 11,415 people (4%) were classified as statin users and 263,967 (96%) as non-statin users. Those who used statins had significantly lower risks of cardiovascular events, stroke, and MI compared with non-statin users; the adjusted hazard ratios in the multivariate analysis were 0.90 (95% confidence interval [CI], 0.82 to 0.98), 0.88 (95% CI, 0.80 to 0.98), and 0.91 (95% CI, 0.79 to 1.07), respectively. When we calculated the mediating effect of cardiovascular events by statin use through HZ, 11.6% of the total beneficial effect of cardiovascular events by statin use was mitigated through the occurrence of HZ caused by statin use. This mediating effect was higher in the younger age group (< 60 years).
Conclusions
This study showed that statin use reduced CVD by 10%, but the protective effect of statin use against CVD was mitigated by approximately 10% through the development of HZ caused by statin use.

Keyword

Herpes zoster; Stroke; Myocardial infarction
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