Photo Credit CDC PHIL
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During a major influenza pandemic, a billion people . . . perhaps more, could fall seriously ill over the course of a few short months.
And the reality is, without pharmacological intervention, millions could die.
But flu vaccines take months to manufacture, and our ability to produce and distribute them remains woefully inadequate. Antivirals are in short supply as well, are expensive, and may produce unwanted side effects. They might even prove ineffective if the pandemic strain is resistant.
What the world desperately needs is a cheap (preferably generic) medication that will help treat severe influenza cases.
It needs to be a shelf stable pill, that is easy to dispense, has a low incidence of side effects, and can reduce influenza morbidity and mortality.
That’s a tall order, but there are some researchers who believe that statins – cholesterol lowering drugs – might fill the bill.
Over the years we’ve seen a number of studies that have suggested that taking statins can improve survival rates among those with influenza and/or pneumonia.
The idea of using them in a pandemic has been largely championed by Dr. David Fedson – former Professor of Medicine at the University of Virginia School of Medicine and formerly Director of Medical Affairs, Aventis Pasteur MSD who has urged that scientists look seriously at statins, which he believes may help modulate the immune response.
A couple of his papers on the subject include:
Pandemic Influenza: A Potential Role for Statins in Treatment and Prophylaxis
David S. Fedson
New Approaches to Confronting an Imminent Influenza Pandemic
Dr. Fedson and Peter Dunnill, DSc,FREng
In 2007 we saw a study that seemed to support the idea, as it indicated that statins lowered the mortality rate of those 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.
And in 2008 another encouraging report made the headlines:
Statins may cut pneumonia death, blood clot risks
27 Oct 2008 20:00:13 GMT
Source: Reuters
By Will Dunham
WASHINGTON, Oct 27 (Reuters) - Cholesterol-fighting drugs known as statins reduced the risk of dying from pneumonia or developing dangerous blood clots in the legs, adding to a growing list of benefits from the popular drugs, two research groups said on Monday.
But not all of the studies have been positive.
In July of 2009 there was a report that found no evidence of benefit among pneumonia patients (see Another Take On Statins And Pneumonia) taking statins.
But more recent studies (here and here) have suggested that those on statins see lower mortality from both seasonal flu and pneumonia. Keeping alive the possibility that statins might play some role in mitigating a future pandemic.
Conflicting medical studies are nothing new. We see them all the time. Science is often messy and we get to the truth by fits and starts – and that can sometimes take years to sort out.
Today, we have another study to add to the mix.
This one comes from Imperial College London, where researchers conducted an 11 year follow up on thousands of UK patients who took part in a landmark statin study (ASCOT Anglo-Scandinavian Cardiac Outcomes Trial) that ended in 2003.
What they found was that those who received statins during the initial trial period (as opposed to a placebo), were 14% less likely to have died over the past 11 years.
This despite the fact that a large number of the placebo group had begun taking statins in the interim.
The difference in mortality was, quite unexpectedly, attributed to fewer deaths from respiratory infections and pneumonia. In fact, statins appeared to have a greater affect on reducing mortality due to respiratory infections than they did on cardiovascular disease.
We’ve a press release and a link to the study.
Statins reduce deaths from infection and respiratory illness, 8 years on from trial
The death rate among patients prescribed a statin in a major trial that ended in 2003 is still lower than those given a placebo, even though most participants in both groups have been taking statins ever since. ASCOT, the Anglo-Scandinavian Cardiac Outcomes Trial, was stopped early because the statin was so effective at preventing heart attacks and strokes, but a new analysis has shown that eight years on, the most significant difference between the groups is a reduction in deaths from infection and respiratory illness.
The latest findings, from researchers at Imperial College London, were presented at the European Society of Cardiology Congress in Paris today and simultaneously published in the European Heart Journal.
In the lipid-lowering arm of the trial, over 10,000 patients in the UK, Ireland and Scandinavia with high blood pressure were randomly allocated either atorvastatin or placebo between 1998 and 2000. In 2003, the trial was stopped early because the statin proved to be highly beneficial in preventing heart attacks and strokes. Since then, most participants from both groups have been taking statins.
The new analysis looked at the number and cause of deaths among the 4,605 participants in the ASCOT trial who are based in the UK. After 11 years' follow-up, overall mortality is 14 per cent lower in the group originally assigned atorvastatin, due largely to fewer deaths from infection and respiratory illness.
"This result is very unexpected," said Professor Peter Sever, from the International Centre for Circulatory Health at Imperial College London, who led the study. "The benefits of statins for preventing heart attacks and strokes are well-established, but after long-term follow-up the most significant effects seem to be on deaths from other causes. It's quite remarkable that there is still this difference between the two groups, eight years after the trial finished.”
The study may be read at:
The Anglo-Scandinavian Cardiac Outcomes Trial: 11-year mortality follow-up of the lipid-lowering arm in the UK
Peter S. Sever*, Choon L. Chang, Ajay K. Gupta, Andrew Whitehouse, Neil R. Poulter and on behalf of the ASCOT Investigators
Conclusion Legacy effects of those originally assigned atorvastatin may contribute to long-term benefits on all-cause mortality. An explanation for long-term benefits on non-CV deaths has not been established.
This study (like most) is subject to a number of limitations, including that these researchers did not set out, a priori, to study non-CV deaths, that it was limited to a large segment of the UK cohort of the original ASCOT trial, and that cause of death was taken from available death certificates, which are not always 100% accurate.
Still, the authors believe this study shows a positive effect from early (and probably sustained)use of statins on all-cause mortality.
In an accompanying editorial, Guy G. De Backer calls the results `surprising’, but notes they leave us with with a great many unanswered questions. Not the least of which is what mechanism might be behind this legacy effect of taking statins.
Long-term results from statin trials: answers but more unresolved questions
Guy G. De Backer
While today’s information is tantalizing, definitive answers remain elusive. Better studies are obviously needed - preferably from multiple randomized controlled trials (RCTs).
But studies on the legacy effects of medications can take years, and are both difficult and expensive to mount. So it may be quite some time before we get those answers.
For more on the potential utilization of statins during a pandemic, or for seasonal influenza and pneumonia, you may wish to revisit these earlier blogs:
Statins & Pneumonia: Revisited
