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; Søren P. Johnsen, MD, PhD; Henrik T. Sørensen, MD, DMSc
Archives of Internal Medicine (2008); 168[19]: pp. 2081-2087.
Written by: Peter M Crosta