The American Journal of Medicine
Volume 122, Issue 5 , Page e17, May 2009

The Reply

Royal Infirmary of Edinburgh, Edinburgh, United Kingdom

Article Outline

 

We thank Grau and George for their letter. We agree with their comments that the evidence for the beneficial pleiotropic effects of statins in community-acquired pneumonia is now difficult to deny, with a large number of studies of different designs demonstrating these benefits.1, 2, 3 It also seems increasingly unlikely that healthy user bias can account for all of the effects reported in these studies.4

We agree that the influence of pneumococcal and influenza vaccination may affect the results. The literature is, however, conflicting in this area. Recent studies suggest, conversely, that including vaccination status may have increased, rather than decreased, confounding. They showed no reduction in 30-day mortality or intensive care unit admission associated with influenza vaccination use as the result of a large degree of healthy user confounding.5, 6 No previous study has identified a relationship between vaccination status and complicated parapneumonic effusion or empyema.

We believe that only randomized controlled trials will be able to account for all of the potential confounders.

Further studies are required to elucidate the mechanism of the protective effects of statins and to demonstrate if these effects are truly independent of all potential confounders.

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References 

  1. Mortensen EM, Restrepo MI, Anzueto A, et al. The effect of prior statin use on 30-day mortality for patients hospitalized with community acquired pneumonia. Respir Res. 2005;25;:6;82
  2. Fessler MB, Young SK, Jeyaseelan S, et al. A role for hydroxy-methylglutaryl coenzyme A reductase in pulmonary inflammation and host defense. Am J Respir Crit Care Med. 2005;171:606–615
  3. Chalmers JD, Singanayagam A, Murray MP, Hill AT. Prior statin use is associated with improved outcomes in community-acquired pneumonia. Am J Med. 2008;121:1002–1007e1
  4. Majumdar SR, McAllister FA, Eurich DT, et al. Statins and outcomes in patients admitted to hospital with community acquired pneumonia: population based prospective cohort study. BMJ. 2006;333:999
  5. 1 Eurich DT, Marrie TJ, Johnstone J, Majumdar SR. Mortality reduction with influenza vaccine in patients with pneumonia outside “flu” season: pleiotropic benefits or residual confounding?. Am J Respir Crit Care Med. 2008;178:527–533Epub 2008 Jun 12
  6. Jackson ML, Nelson JC, Weiss NS, et al. Influenza vaccination and risk of community-acquired pneumonia in immunocompetent elderly people: a population-based, nested case control study. Lancet. 2008;372:352–354

PII: S0002-9343(09)00052-7

doi:10.1016/j.amjmed.2008.12.014

Refers to article:

  • Improved Outcomes in Community-acquired Pneumonia with Prior Statin Use

    Andres C. Marte Grau, Sajid M. George
    The American Journal of Medicine May 2009 (Vol. 122, Issue 5, Page e15)

The American Journal of Medicine
Volume 122, Issue 5 , Page e17, May 2009

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