Friday, June 19, 2009

Another Take On Statins And Pneumonia





# 3365



Often we are confronted with conflicting studies.  


One will show some medicine, or procedure, to be beneficial while another will show no effect, or worse, a negative effect.


Like the `Tastes Great!’ vs.  `Less Filling’  beer wars of the 1970’s, we often see a seesawing of opinions as new data gets released.  


In the end, it is often hard to know which study to believe.


Over the past few years we’ve seen a number of highly publicized studies suggesting that Statins (a class of cholesterol lowering drugs) had other benefits as well. 


In April of 2007 we saw a study that indicated that statins, indeed, lowered the mortality rate of people with pneumonia.


Statin drugs lower respiratory death risk: study

Tue Apr 10, 2007 12:40pm EDT

By Maggie Fox, Health and Science Editor

WASHINGTON (Reuters) - People who use statin drugs are less likely to die of influenza and chronic bronchitis, according to a study that shows yet another unexpected benefit of the cholesterol-lowering medications.


Their study of more than 76,000 people showed that those who had taken statins for at least 90 days had a much lower risk of dying from chronic obstructive pulmonary disease or COPD, the technical name for emphysema and chronic bronchitis.


Patients on statins also had a lower risk of dying from influenza or pneumonia, the researchers reported on Monday.



Today, however, we get a new study that disputes these findings.  


My thanks to @frLucy on Twitter who credits Yeff, for sending me the link to this newest report.



Statins don't lower risk of pneumonia in elderly

British Medical Journal study includes 3,000 Group Health patients

SEATTLE— Taking popular cholesterol-lowering statin drugs, such as Lipitor® (atorvastatin), does not lower the risk of pneumonia. That's the new finding from a study of more than 3,000 Group Health patients published online on June 16 in advance of the British Medical Journal's June 20 print issue.


"Prior research based on automated claims data had raised some hope—and maybe some hype—for statins as a way to prevent and treat infections including pneumonia," said Sascha Dublin, MD, PhD, a physician at Group Health and assistant investigator at Group Health Center for Health Studies. "But when we used medical records to get more detailed information about patients, our findings didn't support that approach."


In fact, Dublin's population-based case-control study found that pneumonia risk was, if anything, slightly higher (26%) in people using a statin than in those not using any; and this extra risk was even higher (61%) for pneumonia severe enough to require being hospitalized.


(Continue . . .)



Generic statins have been held out as a potential pandemic flu medication due to their anti-inflammatory properties.   They are easy to manufacture, relatively cheap, and easier to distribute than scarce vaccines.


Not a cure, of course - but potentially lifesaving – particularly in developing nations where other interventions may not exist.


This study would seem to deflate those hopes a bit, although this is unlikely to be the final word on this debate.


Here is the study from the BMJ.


Published 16 June 2009, doi:10.1136/bmj.b2137
Cite this as: BMJ 2009;338:b2137


Statin use and risk of community acquired pneumonia in older people: population based case-control study

Sascha Dublin, assistant investigator1,2, Michael L Jackson, EIS officer1, Jennifer C Nelson, associate investigator1,3, Noel S Weiss, professor2, Eric B Larson, executive director and senior investigator1,4,5, Lisa A Jackson, senior investigator1,2

Objective To test the hypothesis that hydroxymethyl glutaryl coenzyme A reductase inhibitors (statins) may decrease the risk of community acquired pneumonia.

Design Population based case-control study.


Setting Group Health, a large integrated healthcare delivery system.

Population Immunocompetent, community dwelling Group Health members aged 65 to 94; two matched controls for each case with pneumonia. Information on comorbid illnesses and functional and cognitive status, potential confounders of the association between statin use and risk of pneumonia, came from medical record review and computerised pharmacy data.

Main outcome measure Adjusted estimates of risk of pneumonia in relation to current statin use.


Results 1125 validated cases of pneumonia and 2235 matched controls were identified. Compared with controls, cases were more likely to have chronic lung and heart disease, especially severe disease, and functional or cognitive impairment.

Current statin use was present in 16.1% (181/1125) of cases and 14.6% (327/2235) of controls (adjusted odds ratio 1.26, 95% confidence interval 1.01 to 1.56). Among cases admitted to hospital and matched controls, current statin use was present in 17.2% (68/395) of cases and 14.2% (112/788) of controls (adjusted odds ratio 1.61, 1.08 to 2.39, compared with non-use).

In people in whom statins were indicated for secondary prevention, the adjusted odds ratio for risk of pneumonia in relation to current statin use was 1.25 (0.94 to 1.67); in those with no such indication, it was 0.81 (0.46 to 1.42).

Conclusions Statin use was not associated with decreased risk of pneumonia among immunocompetent, community dwelling older people. Findings of previous studies may reflect "healthy user" bias.


Anonymous said...

Hi Mike,

I know you also visit Effect Measures. I posted a comment/question today about the positive effects of Vitamin D (at least my post here is a little more relevant to your discussion of statins). Revere offered a very gentle and honest response to my question, that actually mirrors my own dearth of medical instruction in nutrition and supplements. I subsequently posted two links there, that I found pretty impressive in favor of supplemental Vit.D in much larger doses than we get in fortified milk or supplements (minimum of 2,000 I.U./day, vs. 500 found in most multi-vit. supplements).

As you know from my previous posts here, I highly respect your fund of knowledge, your dedication to covering this emerging threat, and your very humble and down-to-earth (and therefore very enlightening) discussions.

Do you have an opinion on Vit. D.'s salutary effects on the immune systems competence in actually preventing or amelioration an influenza infection?

Thank you, Mike

FLA_MEDIC said...

Paul, I've read a number of the anecdotal reports and a few studies, and they sound promising, but I'm not exactly qualified to interpret the data.

I can tell you that my Lyme specialist is pretty high on Vitamin D, and at his urging, I've added it to my repertoire of supplements.

He admits that it is all guesswork, but he believes 2000 IU per day for ADULTS is a reasonable amount for daily maintenance.

The NIH . . .

. . . Lists 2,000 IU as an Upper Limit daily dose for adults >, but acknowledges that some nutritionists have pushed for that to be raised.

I honestly don't know if it will help with influenza (prevention or recovery ).

But I do plan to take it, simply because . . . it couldn't hurt.

(This is not an offer of medical advice, and no one should interpret it as anything but a statement about what I plan to do for my own health.)

Anonymous said...


That's good enough for me! I'm on it! And I'll offer it to my family as advice, though I've encountered great frustration with my young adult children to take any of this seriously. What else can I do? Life experiences (and sometimes death) is a more exacting teacher than a father can ever be.