association of statin use and risk for

8/18/2019 Association of Statin Use and Risk For

1/20

ASSOCIATION OF STATIN USE AND RISKFORSEVERE HEADACHE OR MIGRAINE BYSERUM

VITAMIN D STATUS: A CROSS-SECTIONALPOPULATION-BASED STUDY

Disusun Oleh :


2/20

INTRODUCTION


3/20

Use of statin medications has been associated with both increased anddecreased risk for migraine and headache.Statins may have variable effect on headache related to an interactionbetween statin and vitamin D status.

Use ! s"#"in

L $ %i"#&in Ds"#"us

Hi'he( %i"#&in Ds"#"us

Hi'he( )(e%#len*e! e+)e(ien*in'

se%e(e he#,#*he

( &i'(#ine

L $e( )(e%#len*e! e+)e(ien*in'

se%e(e he#,#*he( &i'(#ine


4/20

METHODS


5/20

A cross-sectional study using data from the National Health and

Nutrition E amination Survey !NHANES"# a strati$ed multistage%robability survey of the civilian# non-institutionali&ed United States%o%ulation'e analy&ed data from the ())*+()), NHANES# as those were theonly years for which information on %rimary e %osures of interest#

serum ( -hydro y vitamin D !( ! H"D" and statin use# as well as theoutcome# severe headache or migraine# was available using in-home interview/easurements of serum ( ! H"D were %erformed at the 0enters forDisease 0ontrol in Atlanta# 1A# using the DiaSorin 23A kit !Stillwater#

/N"


6/20

OTHER COVARIATES

4rinci%al confounders%reviously known orsus%ected to beassociated with statin useor to affect therelationshi% betweenstatin use and vitamin D

Confounders

AgeSex

Ethnicity/race

Educational

attainment

Self-reporte

dhealthstatus

Physical

activity

Smoking

Alcoholintake

Bodymassindex

(B !"

Coronary

heartdiseas

e

#istoryof

stroke

$um%er of

timesseen

%ydoctor

$um%er ofconcurren

tmedicatio

n use

&se ofspeci'c painrelief


7/20

e )e(! (&e, sensi"i%i". #n#l.ses " e+)l (e i! use ! "he(&e,i*#"i ns ( * n,i"i ns in/uen*e, u( (esul"s

SENSITIVITY AND POST HOC ANALYSES

D "he.in/uen*e,

u((esul"00

S.s" li* 1l ,)(essu(e

Di#1e"es

Sel! (e) (",e)(essi n2#n+ie".2e& "i n#l

)( 1le& Use !)(e%en"i%e&i'(#ine"he(#).

P s" 3&en )#us#ls"#"us2

e+ 'en ush (& ne

C#(,i %#s*ul#( &e,i*#"i ns4e+*e)" ! ( s"#"in #n, #s)i(in5$e(e (e& %e, !( & "he in& ,el " #% i, (e,un,#n*.

Pe(! (&e, #n#l.ses(es"(i*"in' & ,els 465 "#'e '(e#"e( "h#n 77 .e#(s8#n, 495 " $ &en ;.e#(s8 $hile #,,in' #%#(i#1le ! ( use !es"( 'en-* n"#inin'* n"(#*e)"i%es ( HCT


8/20

RESULTS


9/20

THE CHARACTERISTICS OF THESTUDY

PARTICIPANTS ACCORDING TO STATIN USE4NHANES 9;;639;; 8 < ; YEARS5


10/20

CHARACTERISTICS OF THE PARTICIPANTS

ACCORDING TO SERUM 974OH5D 4NHANES 9;;639;; 8 < ; YEARS5


11/20

PREVALENCE OF SEVERE HEADACHE ORMIGRAINE


12/20

AD=USTED ODDS RATIOS 4OR5 AND >7? CONFIDENCE INTERVALS4CI5 OF THE EFFECT OF STATIN AND OTHER CARDIOVASCULARMEDICATIONS ON SEVERE HEADACHE OR MIGRAINE IN THEOVERALL SAMPLE AND STRATIFIED BY VITAMIN D STATUS4NATIONAL HEALTH AND NUTRITION E@AMINATION SURVEY89;;639;; 8 < ; YEARS5


13/20

'e found5o A signi$cant association between statin use and a lower %revalence of

severe headache or migraine# ad6usted odds ratio ! 2"5 ).78 !9 :con$dence interval !03"5 ).,7# ).9;"

o A statistically signi$cant interaction between these factors# with a lower%revalence of severe headache or migraine for statin use and( ! H"D< 8 nmol=l !% for interaction>).)) "

?o account for the %ossibility that endogenous or e ogenous estrogenin@uenced

1)Restricting age to ≥55 years in men and women• 3n overall model 2 of ).7( !9 : 035 ).,*# ).9 "• ?hose with ( ! H"D 8 nmol=l 2 of ).;( !9 :035 ). )# *.B8"• ?hose with ( ! H"D< 8 nmol=l 2 of ).BB !9 : 035).*8# ).77"

2) Restricting the sample to women only, for ages ≥40 years, andincluding use of e ogenous estrogen

• 3n overall model 2 of ).8* !9 :035 ).,B# *.*7"• ?hose with ( ! H"D 8 nmol=l 2 of ).9* !9 : 035 ). (# *. 8"• ?hose with ( ! H"D< 8 nmol=l 2 of ).,B !9 : 035 ).()# ).9*"


14/20

DISCUSSION


15/20

?his study is based on the association between migraine with aura and therisk for develo%ing vascular disease# most notably stroke and suggestedassociations between vascular diseases and any migraine# although the latter

remains controversialHy%othetical mechanism# endothelial dysfunction %recursor to vasculardisease# may be both a conseCuence of migraine and a %ossiblecause=contributor of migraine %athogenesisEvidence for endothelial dysfunction in migraine5

Several studies have shown an association of migraine with increasedaugmentation inde !A3 "#

In*(e#se, "u& (ne*( sis !#*" (

4TNF5#l)h#

In*(e#se,in"e(leu in

4IL5-65

In*(e#se,"h( &1 sis 4% nille1(#n, !#*" (4% F5 #*"i%i".

In*(e#se,

)l#s&in 'en#*"i%#" ( #n"i'en

Al"e(#"i ns in "he

ni"(i* +i,e)#"h$#.


16/20

Statin may reduce attack freCuency of migraine by 5

it seems unlikely that statins might decrease migraine via a direct actionon cholesterol reduction# suggesting further investigations on li%idinde%endent actions would be of most interest3t is s%eculated that the effects of statin are facilitated by vitamin D#which has overall anti-in@ammatory effects on cytokinesAnother s%eculation on how vitamin D might interact with statin toreduce migraine involves muscle %ain# a sus%ected trigger of migrainewhen occurring in the neck

6 I&)( %in' en, "heli#l !un*"i n

9 I&)( %in' #("e(i#l s"i ness

I&)( %in' &us*ul#( " ne

Re,u*e in/#&" (. (es) nse

7 De*(e#se, )l#"ele" #''(e'#"i n #n, "h( &1 sis


17/20

STUDY LIMITATION

In*lu,e, nl. )e )le < ;.e#(s in (,e( " e%#lu#"es"#"in use . n " 1e'ene(#li #1le " . un'e(

in,i%i,u#ls

Al"h u'h $e #, us"e,! ( se%e(#l* n! un,e(s8 (esi,u#l

* n! un,in' .e+is"

Ou"* &e1#se, n sel!-

(e) ("

Al"h u'h 974OH5Dsh $e, # n (l

,is"(i1u"i n8 "he (#n'e$#s (el#"i%el. n#(( $8

$hi*h )(e%en"e, us !( &e+#&inin' hi'he( le%els

Ou( n,in's ! , i*h " &i e,%e(sus line#( & ,els !

974OH5D #(e * nsis"en" $i"h"he n "i n "h#" "he e e*" !

974OH5D n s"#"in use isn nline#(

This s"u,. *#nn " #,,(ess*#us#li". ( "he ,i(e*"i n !

"he #ss *i#"i n $e1se(%e, 1e"$een s"#"inuse #n, %i"#&in D $i"h

l $e( )(e%#len*e ! se%e(ehe#,#*he ( &i'(#ine


18/20

CONCLUSION


19/20

ur %reliminary $ndings indicate that %eo%le who haveserum( ! H"D< 8 nmol=l and use a statin have alower %revalence

of severe headache or migraine. 3tremains to be seenwhether combined treatment withstatin and vitamin Dsu%%lementation might serve as athera%y to %reventheadache or migraine

Clini*#l i&)li*#"i ns S"#"ins h#%e # %#(i#1le e e*" n "he )(e%#len*e !

se%e(e he#,#*he ( &i'(#ine "h#" ,e)en,s n %i"#&in Ds"#"us

S"#"in use in "h se $i"h hi'he( se(u& %i"#&in D le%elsis si'ni *#n"l. #ss *i#"e, $i"h # l $e( )(e%#len*e !h#%in' se%e(e he#,#*he ( &i'(#ine


20/20

THANK YOU

association of statin use and risk for

Documents