Population-Based Study of Statins, ARBs, and ACE inhibitors on Pneumonia-Related Outcomes.
Clin Infect Dis. 2012 Aug 23;
Authors: Mortensen EM, Nakashima B, Cornell J, Copeland LA, Pugh MJ, Anzueto A, Good C, Restrepo MI, Downs JR, Frei CR, Fine MJ
Introduction.?Studies suggest that statins and angiotensin converting enzyme (ACE) inhibitors might be beneficial for infections. Our purpose was to examine the association of statin, ACE inhibitor, and angiotensin-receptor blocker (ARBs) use with pneumonia-related outcomes.Methods.?We conducted a retrospective cohort study using Department of Veterans Affairs data of patients ? 65 years hospitalized with pneumonia. We performed propensity-score matching for 3 medication classes simultaneously.Results.?Of 50,119 potentially eligible patients, we matched 11,498 cases with 11,498 controls. Mortality at 30-days was 13%; 34% used statins, 30% ACE inhibitors, and 4% ARBs. In adjusted models, prior statin use was associated with decreased mortality (odds ratio 0.74, 95% confidence interval 0.68-0.82) and mechanical ventilation (0.81, 0.70-0.94), and inpatient use with decreased mortality (0.68, 0.59-0.78) and mechanical ventilation (0.68, 0.60-0.90). Prior (0.88, 0.80-0.97) and inpatient (0.58, 0.48-0.69) ACE inhibitor use were associated with decreased mortality. Prior (0.73, 0.58-0.92) and inpatient ARB use (0.47, 0.30-0.72) were only associated with decreased mortality. Use of all three medications was associated with reduced length of stay.Discussion.?Statins, and to a lesser extent ACE inhibitors and ARBs, are associated with improved pneumonia-related outcomes. Prospective cohort and randomized controlled trials are needed to examine potential mechanisms of action and whether acute initiation at the time of presentation with these infections is beneficial.
PMID: 22918991 [PubMed - as supplied by publisher]