According to an article published in the October 27 issue of Archives
of Internal Medicine, people who were hospitalized with
pneumonia were less likely to die within 90 days afterward if they took
cholesterol-lowering statins before hospitalization.
In the last ten years, the United States and Europe have seen
a 20 to 50% increase in pneumonia hospitalization rates. In addition,
some 10 to 15% of pneumonia patients die from the disease. It has been
suggested in a recent review article that patients with infections of
the bloodstream (sepsis) or with the presence of bacteria in the
bloodstream (bacteremia) may benefit from the ability of statins to act
against clotting, inflammation, and modifications of immune functions.
Following this lead, Reimar W. Thomsen, M.D., Ph.D. (Aarhus University
and Aalborg Hospital, Aalborg, Denmark) and colleagues analyzed data
from 29,900 adults who, between 1997 and 2004, were hospitalized with
pneumonia. Just 4.6% (1,371 patients) were also taking statins at the
time.
The authors found that, "Mortality [death] among statin users was lower
than among non-users: 10.3 percent vs. 15.7 percent after 30 days and
16.8 percent vs. 22.4 percent after 90 days." Patients who were older
than 80 and those with bacteremia had the lowest relative death rate
associated with statins. "The differences became apparent during the
first few weeks of hospitalization, a period associated with a high
number of pneumonia-related deaths, and they increased only minimally
between 30 and 90 days after admission, which suggests that statin use
is beneficial primarily in the early phase of infection," add the
researchers.
Patients who previously (not currently) used statins or any other
preventive cardiovascular drug, however, did not have reduced rates of
death due to pneumonia.
"Several biological mechanisms may explain our results," write Thomsen
and colleagues. Statins are known to alter immune response, help
processes linked to blood clotting and inflammation, and prevent
dysfunction in blood vessels. Sepsis and bacteremia - conditions
associated with early death from pneumonia - may also be affected by
statins through these mechanisms.
"Our study adds to the accumulating evidence that statin use is
associated with improved prognosis after severe infections," conclude
authors. "The decrease in mortality associated with statin use seems to
be substantial in patients with pneumonia requiring hospital admission.
Randomized trials are needed to examine causality of the associations
found in observational studies. Given the availability of statins, with
their relatively low cost and mild adverse effects, positive results of
statin therapy trials in patients with pneumonia would have substantial
clinical and public health implications."
In an accompanying editorial, Kasturi Haldar, Ph.D.
(University of Notre Dame, South Bend., Ind.) writes that, "These data
suggest a substantial decrease in mortality with statin use."
The results of Thomsen and colleagues "raise the question of whether
statins should be used to improve anti-infective therapy. They are not
optimal for treating acute infection because it takes days to achieve
the desirable concentrations in plasma."
"However, because statins target the host, drug resistance, a major
problem in treating bacterial infections, is not likely to develop."
Haldar concludes by noting that, "It may be useful to consider clinical
research testing of combinations of statins with existing antibiotic
agents to evaluate whether it is possible to develop optimized
combination therapies effective against both acute and persistent
infections."
Preadmission Use of Statins and Outcomes After Hospitalization
With Pneumonia
Reimar W. Thomsen, MD, PhD; Anders Riis, MSc; Jette B. Kornum, MD;
Steffen Christensen, MD; S??ren P. Johnsen, MD, PhD; Henrik T. S??rensen,
MD, DMSc
Archives of Internal Medicine (2008); 168[19]:
pp. 2081-2087.
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Written by: Peter M Crosta