Statins in survivors of traumatic brain injury: a propensity score-matched analysis.

BACKGROUND: Several in-vitro and animal studies suggest that statins may have beneficial effects on clinical outcomes of traumatic brain injury (TBI), however, clinical data are scarce. OBJECTIVES: To examine the association of statin use with TBI clinical outcomes among patients with TBI. METHODS: A retrospective cohort study of Tricare beneficiaries who had a TBI diagnosis, as defined by the Barbell injury diagnosis matrix. Outcomes were defined using ICD-9 codes and included: post-concussion syndrome, neurological disorders, substance dependence or abuse, and psychiatric disorders. Statin-users and non-users were propensity score (PS)-matched using 103 baseline characteristics. RESULTS: Out of 1187 adult patients with a TBI diagnosis (172 statin-users and 1015 nonusers), we PS-matched 70 statin-users to 70 non-users. There were no statistically significant differences in the PS-matched cohort of statin-users in comparison to nonusers for post-concussion syndrome (odds ratio [OR]: 0.24, 95% confidence interval [CI]: 0.03-2.20), neurological disorders (OR: 0.60, CI: 0.31-1.16); substance dependence or abuse (OR: 0.80, CI: 0.40-1.60), or psychiatric disorders (OR 0.80, CI: 0.41-1.55). CONCLUSION: This study did not show benefit or harm for statins among survivors of TBI. Our findings do not support the evidence from some animal studies and small randomized controlled trials. Further studies utilizing larger sample sizes are warranted.

Translational manipulation under anesthesia for patients with frozen shoulder: a case series study with five-year health care utilization and post-manipulative arthroscopic findings.

STUDY DESIGN: Case series study. OBJECTIVES: Although there have been no reported complications from translational manipulation under anesthesia (tMUA) for individuals with adhesive capsulitis (AC) there are no cases reporting surgical findings post tMUA. Also, there are no studies evaluating health care utilization following tMUA. The purpose of this study was to: (1) report clinical outcomes following tMUA, (2) describe relevant health care costs and utilization following tMUA, and (3) summarize findings from two cases receiving joint arthroscopy following tMUA. METHODS: Fourteen Individuals with AC underwent tMUA. Range of motion (ROM) and Shoulder Pain and Disability Index (SPADI) values were collected at baseline and six weeks follow-up. Shoulder-related health care cost and utilization were analyzed for a five-year period following tMUA. Two additional patients with AC underwent tMUA followed by arthroscopic assessment for evidence of iatrogenic injury. RESULTS: Thirteen patients completed the six-week follow-up. Mean change scores for ROM and SPADI values were flexion; +38.5°, abduction; +71.1°, external rotation (shoulder abducted); +49.8°, internal rotation (shoulder abducted); +26.6°, SPADI scores; +44.4. 13 patient records were analyzed for health care utilization. Ten of the 13 patients utilized no additional shoulder-related health care. Surgical evaluation revealed no evidence of iatrogenic injury. DISCUSSION: Clinical outcomes were similar to previous studies. Utilization data indicated that for the majority of patients, little shoulder-related health care was utilized. Surgical evaluation provided further evidence that tMUA performed by a physical therapist is safe. Future research will be required to establish a causal relationship between tMUA and the results observed in this study. LEVEL OF EVIDENCE: Therapy, Level 4.

Statins for primary prevention in physically active individuals: Do the risks outweigh the benefits?

OBJECTIVES: There are little data on the potential benefits and adverse events of statins among physically fit individuals. Our objective was to examine the associations of statin use with beneficial cardiovascular outcomes and adverse events in active duty military (a surrogate for high level of physical fitness). DESIGN: This is a retrospective propensity score-matched cohort study of healthy active duty military (fiscal years [FY] 2002-2011). METHODS: Statin-users received statins during FY 2005 as their only prescription medication. FY 2002-2004 was used to describe baseline characteristics; and FY 2006-2011were used to capture outcomes. Study outcomes included major acute cardiovascular events (MACE), diabetes mellitus and its complications, kidney diseases, musculoskeletal diseases, obesity, and malignancy. RESULTS: We propensity score matched 837 statin-users to 2488 nonusers. During follow-up, 1.6% statin-users and 1.5% nonusers were diagnosed with MACE (odds ratio [OR] 1.05, 95% confidence interval [CI] 0.55-1.98), 12.5% of statin-users and 5.8% of nonusers were diagnosed with diabetes (OR 2.34, 95% CI 1.79-3.04), and 1.7% statin- users and 0.7% nonusers were diagnosed with diabetes with complication (OR 2.47, 95% CI 1.21-5.04). There were no differences in rates of other adverse events. CONCLUSIONS: Among healthy physically active individuals, statin use was associated with doubled the odds of diabetes and diabetic complications without countervailing cardiovascular benefits.