engleski

Statins and risk of acute pancreatitis: a meta- analysis of observational studies

Introduction: Existing reports on the association between statins administration and the risk of developing acute pancreatitis (AP) are contradictory. Statins are widely perceived as potential etiological factors for AP, but more recent evidence suggests the opposite. The mechanisms of their possible benefit is still unclear, with experimental studies showing potential specific anti-inflammatory aspects. The latest meta-analysis on this topic evaluted only clinical trials, excluding observational studies and found a reduced risk of AP in statin users. Aims & Methods: The aim of this systematic review and meta-analysis was to evaluate the association between the use of statins and the risk of developing AP. Medline, Scopus, and Web of Science were searched for cohort (C) and casecontrol (CC) studies in which statins are included as an intervention and AP as an outcome regardless of publication language. Two authors independently searched the literature and extracted data. Disagreements were solved by discussion and by decision of a third author. Eligible studies were selected according to the PRISMA statement. Pooled adjusted ORs with corresponding 95% CIs were calculated using random effects model. Publication bias was assessed through Begg and Mazumdar test. Heterogeneity was assessed by means of the I2 value. Results: A total of 13 studies (7 CC, 6 C) contributed to the analysis. A total of 34899 AP patients and 5377894 controls were included. The pooled prevalence of statin use was 9.8% (3411/34, 899) among AP patients and 25% (1357175/5377894) among controls. The pooled adjusted OR for the 13 studies was 1.00 (95% CI 0.63–1.59 ; p=0.99) with considerable heterogeneity (I2=98%). In a sensitivity analysis for study design, case- control studies were associated to an increased risk (OR 1.33 ; 95% CI 1.20–1.47 ; p5 0.0001), but cohort studies were not (OR 0.69 ; 95% CI 0.37–1.31 ; p ¼ 0.26). Similarly, in a sensitivity analysis for country of origin no association with the risk was seen for Western countries (OR 0.90 ; 95% CI 0.52–1.56 ; p=0.71) while there was an increased risk in studies conducted in Asia (OR 1.39 ; 95% CI 1.10–1.75 ; p=0.006). There was evidence of publication bias (Begg and Mazudmar Kendall’s tau = 0.549 ; p=0.006) suggesting that studies showing an increased risk of AP associated with statin use were more likely to be published than studies with negative results. Conclusion: The results of the first meta- analysis of observational studies for the association between statins use and AP suggest the absence of an increased risk in statin users. Evidence for an increased risk is limited to case-control studies, while cohort studies showed no global effect, similarly to previous data from controlled trials. Further research on the topic is needed to clarify whether statin type, dosage, lenght of use or etiology of AP might account for this difference.

Statins, acute pancreatitis, meta-analysis, observational studies

nije evidentirano