30-day mortality and incidence of complicated pneumonia were significantly lower

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Do Statins Improve CAP Outcome?

In a prospective observational study, 30-day mortality and incidence of complicated pneumonia were significantly lower in patients on statins than in those not on statins.

Several retrospective studies have demonstrated improved outcomes among patients with community-acquired pneumonia (CAP) who are taking statins. Some researchers believe that these medications not only lower serum cholesterol levels but also may produce beneficial anti-inflammatory and immunoregulatory effects. However, others have argued that these potential benefits can be explained by the "healthy-user" effect — i.e., that being on a statin is a marker for better health and improved access to healthcare.

To examine this issue, researchers performed a prospective observational study of consecutive patients admitted to an Edinburgh, Scotland, hospital with CAP between January 2005 and November 2007 (n=1007). The patients’ use of statins and of other cardiovascular drugs was analyzed.

The patients on cardiovascular drugs were significantly older and more likely to have underlying medical conditions than were the patients not taking these drugs. Nonetheless, in multivariate analysis, statin use was associated with lower 30-day mortality risk (adjusted odds ratio, 0.46; 95% confidence interval, 0.25–0.85), whereas Pneumonia Severity Index class 4 (AOR, 4.09; 95% CI, 2.46–6.77) and β-blocker use (AOR, 1.97; 95% CI, 1.03–3.78) were associated with higher risk. Statin use was also associated with decreased risk for developing complicated pneumonia (AOR, 0.44; 95% CI, 0.25–0.79). In addition, statin use was associated with lower C-reactive protein (CRP) levels on admission (median, 176 mg/L vs. 182 mg/L; P<0.001) and with lower risk that CRP would fail to fall by 50% after 4 days of therapy (AOR, 0.52; 95% CI, 0.30–0.89).

Comment: Striking dissimilarities between the control population and those receiving cardiovascular drugs complicate the interpretation of these study findings. However, no cardiovascular drugs other than statins were associated with improved outcomes, and the effects of factors such as Pneumonia Severity Index class were predictable.

— Neil M. Ampel, MD

Published in Journal Watch Infectious Diseases November 19, 2008

Citation(s):

Chalmers JD et al. Prior statin use is associated with improved outcomes in community-acquired pneumonia. Am J Med 2008 Nov; 121:1002.

Medline abstract (Free)

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