Helena L. Chang

Statins Associated with Decreased Risk of New Onset Inflammatory Bowel Disease

Objectives:Prior studies suggest that medication exposures may be associated with new onset inflammatory bowel disease (IBD). The aim of this study was to determine the effect of statins on the risk of new onset IBD in a large United States health claims database.Methods:We conducted a retrospective matched case–control study with a national medical claims and pharmacy database from Source Healthcare Analytics LLC. We included any patient aged 18 or older with ICD-9 code 555.x for Crohn’s disease (CD) or 556.x for ulcerative colitis (UC) between January 2008 and December 2012. IBD patients diagnosed in 2012 were compared with the age group, gender, race, and geographically matched controls. Controls had no ICD-9 codes for CD, UC, or IBD-associated diseases and no prescriptions for IBD-related medications. New onset IBD patients were defined as having at least three separate CD or UC ICD-9 codes and no IBD-related ICD-9 or prescription before first IBD ICD-9. Statin exposure was assessed by Uniform System of Classification level 5 code. To account for diagnostic delay, exposures within 6 months of first ICD-9 were excluded. Exposures within 12 and 24 months were excluded in sensitivity analyses. Conditional logistic regression was used to estimate odds ratios (OR) and 95% confidence intervals (CI) for new onset IBD, CD, and UC.Results:A total of 9,617 cases and 46,665 controls were included in the analysis. Any statin exposure was associated with a significantly decreased risk of IBD (OR 0.68, 95% CI 0.64–0.72), CD (0.64, 95% CI 0.59–0.71), and UC (OR 0.70, 95% CI 0.65–0.76). This effect was similar for most specific statins and regardless of intensity of therapy. The protective effect against new onset CD was strongest among older patients. Statins’ association with a lower risk of IBD was similar after adjusting for antibiotics, hormone replacement therapy, oral contraceptives, comorbidities, and cardiovascular medications.Conclusions:Statins may have a protective effect against new onset IBD, CD, and UC. This decreased risk is similar across most statins and appears to be stronger among older patients, particularly in CD.

Bariatric surgery is associated with increased risk of new‐onset inflammatory bowel disease: case series and national database study

Case series suggest a possible association between bariatric surgery and incident IBD.

Response to Cote-Daigneaut et al.

To the Editor: We read with interest the article by Ungaro et al. ( 1 ) evaluating the eff ect of statins on the risk of new onset Infl ammatory Bowel Disease (IBD). Th e author found that statins may have a protective eff ect against new onset IBD, Crohn’s Disease (CD), and Ulcerative Colitis (UC). Because their fi ndings are important to both current practice and future research, several questions deserve attention. First, as stated in Ungaro’s study, some potential confounders such as cigarette smoking, diet, early life exposures, or family history of IBD were not included in the database, and these confounders may infl uence the risk of IBD. Another study by Khalil D also examined the eff ect of statins on the development of IBD ( 2 ). But they concluded that the risks of IBD among statins users and nonusers are similar aft er adjusting for other potential confounders. And these confounders included cigarette smoking, aspirin, Nonsteroidal anti-infl ammatory drugs (NSAID). Hence, I prefer to accept the results of Khalil D’s study. Second, previous studies about statins and IBD have confl icting results. In a large retrospective cohort study, statins use among patients with IBD was associated with reduced use of oral steroids, particularly for UC ( 3 ). In contrast, two case reports describe the development of fatal UC aft er starting simvastatin in a 65-yearold man, and colitis aft er starting pravastatin in an 80-year-old woman ( 4 ). Some researchers argued that the eff ect of statins on the omega-3/omega-6 ratio may result in increased gastrointestinal infl ammation and the eff ect of statins in decreasing cholesterol may result in lower levels of 6. Finegold JA , Manisty CH , Goldacre B et al. What proportion of symptomatic side eff ects in patients taking statins are genuinely caused by the drug? Systematic review of randomized placebo-controlled trials to aid individual patient choice . Eur J Prev Cardiol 2014 ; 21 : 464 – 74 .

Corrigendum: Statins Associated with Decreased Risk of New Onset Inflammatory Bowel Disease

Corrigendum: Statins Associated with Decreased Risk of New Onset Inflammatory Bowel Disease