Lipid-lowering agents and the risk of XXXX in a Medicaid population.

@entity3604 @entity407 @entity1 @entity174 @entity303 @entity170 @entity173 @entity2453 @entity130
CONTEXT: Three recent nested case-control studies conducted in automated databases suggest that users of @entity2453 reductase inhibitors (statins) have a risk of hip and other @entity3604 half that of non-users of any lipid-lowering drug. However, this comparison may be biased by unmeasured factors associated with treated @entity407 . OBJECTIVE: To compare the risk of @entity173 among users of statins and other lipid-lowering agents, which is less susceptible to bias than the comparisons performed in the previous studies. DESIGN AND SETTING: Retrospective cohort study conducted in the Tennessee Medicaid program between 1 January 1989 through 31 December 1998. SUBJECTS: New users of all lipid-lowering drugs and randomly selected non-user controls who at baseline were at least 50 years of age and did not have life threatening illness, nursing home residence, or diagnosed @entity303 or @entity170 . There were 12506 @entity1 with new use of statins, 4798 with new use of other lipid lowering drugs, and 17280 non-user controls. MAIN OUTCOME MEASURE: Fracture of the proximal femur (hip), excluding pathological @entity174 or those resulting from severe @entity130 . RESULTS: During 66690 @entity1 years of follow up, there were 186 @entity173 (2.8 per 1000). Relative to non-users, the adjusted incidence rate ratios (95% confidence interval) were 0.62 (0.45 to 0.85) for statin users and 0.44 (0.26 to 0.95) for other lipid-lowering drugs. When compared directly with the other drugs, the adjusted incidence rate ratio for statins was 1.42 (0.83-2.43). CONCLUSION: These data provide evidence that the previously observed protective effect of statins may be explained by unmeasured confounding factors.
