Association between Tuberculosis, Statin Use, and Diabetes: A Propensity Score–Matched Analysis

Min-Chul Kim Division of Infectious Diseases, Department of Internal Medicine, Chung-Ang University Hospital, Seoul, Republic of Korea;

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Sung-Cheol Yun Department of Clinical Epidemiology and Biostatistics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea;

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Sang-Oh Lee Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea

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Sang-Ho Choi Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea

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Yang Soo Kim Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea

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Jun Hee Woo Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea

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Sung-Han Kim Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea

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Statins have anti-inflammatory and immunomodulatory properties that may affect the development of tuberculosis (TB). We assessed the association between use of statins and the risk of active TB by propensity score matching. Furthermore, we analyzed the impact of statins on TB in patients according to the presence or absence of diabetes. The study was based on the National Health Insurance database and its subset database of the “medical checkup” population of South Korea. We identified 123,468 statin users and 439,546 non–statin users. After propensity score matching, 28,018 statin users and the same number of non–statin users were finally analyzed. The development of active TB was monitored in these matched pairs over 11 years. In the propensity score–matching analysis, the number of active TB cases was 30 in 30,303 person-years (0.99 per 1,000 person-years; 95% CI, 0.64–1.35) in the statin users and 235 in 167,857 person-years (1.40 per 1,000 person-years; 95% CI, 1.22–1.58) in the non–statin users. Statin users had a significantly lower risk of TB than non–statin users: hazard ratio (HR) 0.67 (95% CI, 0.46–0.98) (P = 0.04). A subgroup analysis showed that statin use reduced the risk of TB in subjects without diabetes, but not in patients with diabetes: HRs were, respectively, 0.28 (95% CI, 0.13–0.60) (P = 0.001) and 1.05 (95% CI, 0.66–1.67) (P = 0.84). There is epidemiologic evidence that statin decreases the risk of active TB. However, the protective effect of statins against TB is attenuated by diabetes.

Author Notes

Address correspondence to Sung-Han Kim, Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, 88 Asanbyeongwon-Gil, Songpa-Gu, Seoul 05505, Republic of Korea. E-mail: kimsunghanmd@hotmail.com

Financial support: This study was supported by a grant from the National Research Foundation of Korea funded by the Ministry of Science, ICT & Future Planning (grant NRF-2018R1D1A1A09082099), and the Asan Institute for Life Sciences (2018-7040).

Authors’ addresses: Min Chul Kim, Division of Infectious Diseases, Department of Internal Medicine, Chung Ang University Hospital, Seoul, Republic of Korea, E-mail: pour-soi@hanmail.net. Sung-Cheol Yun, Asan Medical Center, Department of Clinical Epidemiology and Biostatistics, Seoul, Republic of Korea, E-mail: ysch97@amc.seoul.kr. Sang-Oh Lee, Sang-Ho Choi, Yang Soo Kim, Jun Hee Woo, and Sung-Han Kim, Department of infectious Diseases, Asan Medical Center, Seoul, Republic of Korea, E-mails: soleemd@amc.seoul.kr, sangho@amc.seoul.kr, yskim@amc.seoul.kr, junheewoo@amc.seoul.kr, and kimsunghanmd@hotmail.com.

These authors contributed equally to this work.

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