From Our 2008 Archives

Statins Reduced Death Risk From Pneumonia

By Ed Edelson
HealthDay Reporter

TUESDAY, Oct. 28 (HealthDay News) -- The death rate among people hospitalized for pneumonia was one-third lower for those taking statins than for those not taking the cholesterol-lowering drugs, a Danish study found.

While the findings are preliminary and offer hope, more research is needed before doctors can prescribe statins as infection fighters, experts said.

"I think we need to interpret these findings with caution," said Dr. Reimar W. Thomsen, professor of clinical epidemiology at Aarhus University, and lead author of a report in Oct. 27 issue of the Archives of Internal Medicine.

But statins are known to have an anti-inflammatory effect, Thomsen said, and "we are just beginning to understand that systemic infections such as pneumonia cause inflammation that may trigger a lot of adverse reactions in human bodies."

It's possible that other factors, such as the "healthy-user effect," meaning that people who take statins are in better shape and take better care of themselves, might explain the results of the study, Thomsen added.

"However, we aimed to control for most of the confounding factors in the analyses," he said. "I do not find it likely that confounding explains the whole statin effect."

Other drugs for coronary conditions, such as beta-blockers and aspirin, did not have any effect on pneumonia mortality in the study, Thomsen noted.

Thomsen and his colleagues reviewed data on 29,900 adults hospitalized with pneumonia between 1997 and 2004. Of these, just 1,371 were taking statins at the time. The 30-day death rate for the statin group was 10.3%, compared to 15.7% for those not taking statins. The 90-day death rate was 16.8% for the statin group and 22.4% for those not taking the drugs.

"Healthy user plus biological effects cause this finding," Thomsen said. "The relative impact of both can only be determined by randomized trials. Such trials need to enroll several thousand people with pneumonia, meaning high costs, and would need to include typical pneumonia patients, which are elderly, frail patients with several morbidities."

Until such studies are done, Thomsen said, "I think it is too early to make recommendations about statin therapy for severe infection or treatment. We have learned from the lesson of hormone-replacement therapy and antioxidants, when some doctors and drug companies prematurely recommended drugs on the basis of positive observational studies, that therapeutic recommendations should not be based on animal studies, plausible biological mechanisms, and findings from observational studies."

One controlled trial to see whether statins help treat infections is starting at the University of Chicago.

"We are looking specifically at patients with severe infections, sepsis," said Dr. Jeffrey Jacobson, assistant professor of medicine and leader of the trial. "They will be randomized to simvastatin (Zocor) or placebo for four days."

Jacobson cited the anti-inflammatory properties of statins noted by Thomsen. "My work is specifically about the ability to protect the vasculature [blood vessels]," he said. "If you can prevent vascular leakage, you can reduce morbidity and subsequent complications and mortality."

Several previous observational studies that indicated a protective effect of statins against infection provide "a legitimate rationale for exploring these drugs," Jacobson said. "We do know that clinical trials are long overdue."

The goal is to complete the study within a year, "but it might be closer to two years," Jacobson said.

While he agreed that the current evidence does not support use of statins in the treatment of infections, "what is really promising about them is that they are readily available, relatively safe and affordable, and can be used immediately," he said.

SOURCES: Reimar W. Thomsen, M.D., Ph.D, professor of clinical epidemiology, Aarhus University, Denmark; Jeffrey Jacobson, M.D., assistant professor of medicine, University of Chicago; Oct. 27, 2008, Archives of Internal Medicine

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