Statin Prescription Reduces Risk of Nontuberculous Mycobacteria Pulmonary Infection

Abstract Rationale: Statins, a class of medication in clinical use to reduce cholesterol and protect against cardiovascular disease, have been found effective in reducing infection susceptibility or disease severity due to Mycobacteria tuberculosis. Studies of the effect of statins on related pathogens, nontuberculous Mycobacteria (NTM), are rare. Methods: In this study, we investigated the effect of statin prescription on the population-level risk of NTM pulmonary infection in a cohort of Kaiser Permanente Hawai'i (KPHI) beneficiaries aged ≥ 50 years. KPHI beneficiaries were enrolled during the study period 2005-2019 and were similar to the general Hawai'i population in terms of age, ethnicity, and socioeconomic status. We subset the population to beneficiaries with an indication for statin therapy. Infection was defined as 2 or more isolates of same NTM species from sputum, or 1 isolate in the case of biopsy, bronchoalveolar lavage, or thoracentesis. Statin prescription status was defined as having an active statin prescription for at least 15 days of the previous 30 days for each time point. We analyzed the data using a marginal structural Cox proportional hazards model. Results: Of the 88,398 beneficiaries with an indication for statin therapy, 58,129 (65.8%) had an active prescription. There were 261 NTM infections in the group of beneficiaries without an active prescription, and 21 infections in the group with active prescriptions. Statin prescription was associated with 83.4% reduced hazard of NTM pulmonary infection in this population of beneficiaries with indications for statin therapy. Conclusion: Statin prescription was associated with significantly lower risk of NTM pulmonary infections. The benefits of statin therapy for those at risk of NTM pulmonary disease warrants further research in high-risk populations.