Background: Pharmacoepidemiologic research is a valuable tool to enable one to understand medication utilization patterns, beneficial/harmful outcomes of drug therapy, and to evaluate the impact of other interventions on outcomes of drug therapy in “real-world” settings.
Objectives: This dissertation aimed to apply pharmacoepidemiologic methods to examine (1) changes in utilization patterns of cholesterol-lowering medications following the release of the guidelines and evidence-based data, (2) the associations between statin use and gait speed decline in older adults, and (3) the associations between aspirin, non-aspirin nonsteroidal anti-inflammatory drugs or acetaminophen and risk of ovarian cancer.
Methods: The study samples were from two sources including (1) community-dwelling older adults in the Health, Aging and Body Composition Study, and (2) 902 women with ovarian cancer and 1,802 controls in a population-based case-control study. An interrupted time-series analysis, multivariable generalized estimating equations, and multivariable logistic regression were used to examine our three objectives, respectively.
Results: First, the use of cholesterol-lowering medication increased substantially over a decade in older adults, but was not related to a change in level or trend following the release of the evidence-based guidelines. Secondly, statin use had a decreased risk of gait speed decline. Thirdly, risk reductions of ovarian cancer were observed with the use of aspirin or selective COX-2 inhibitors.
Conclusion: These findings suggest that further studies are needed to investigate risk-benefit balance of cholesterol-lowering therapy and the potential benefits/barriers of the treatment among adults aged ≥ 80 years. Moreover, further investigations are warranted to confirm the risk-benefit balance of statin use and physical function decline in older adults. Future research on the associations between aspirin use and the risk of ovarian cancer should better characterize accompanying medical conditions, health and lifestyle behaviors, genetic susceptibility, and the overall risk-benefit balance. The public health relevance of these findings is that understanding the utilization patterns of cholesterol-lowering therapy and potential benefits of statins on physical function may prevent cardiovascular disease and disability in older adults. In addition, aspirin or COX-2 inhibitors may be potential agents for the prevention of ovarian cancer, the second leading gynecologic cancer in the US
