The American Journal of Medicine
Volume 122, Issue 5 , Page e15, May 2009

Improved Outcomes in Community-acquired Pneumonia with Prior Statin Use

Department of Medicine, Salem Veterans Affairs Medical Center, Salem, Va

Article Outline

 

Dear Editor:

We read with interest the article published by Chalmers et al1 on the improved outcomes in community-acquired pneumonia with prior statin use. It not only provides more evidence of the increasingly identified pleiotropic effects of statins but also makes the “healthy user hypothesis” less likely.

We also agree with the authors that, “No analysis short of a randomized trial can effectively adjust for all potential confounders.”1 However, in a study looking at complicated pneumonia and 30-day mortality, we would like to have seen confounding variables such as prior pneumococcal and influenza vaccination status included. Administration of vaccination prevents hospitalization,2, 3 influenza vaccination decreases complications and mortality,4, 5 and pneumococcal vaccine decreases the rate of invasive disease.6 Some evidence has shown that the rate of mortality or intensive care unit admissions is lower in those who have received the pneumococcal vaccination compared with those who did not,7 which might have affected the authors' findings.

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References 

  1. 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
  2. Butler JC, Breiman RF, Campbell JF, et al. Pneumococcal polysaccharide vaccine efficacy (An evaluation of current recommendations). JAMA. 1993;270:1826–1831
  3. Mullooly JP, Bennett MD, Hornbrook MC, et al. Influenza vaccination programs for elderly persons: cost-effectiveness in a health maintenance organization. Ann Intern Med. 1994;121:947–952
  4. Maciosek MV, Solberg LI, Coffield AB, et al. Influenza vaccination health impact and cost effectiveness among adults aged 50 to 64 and 65 and older. Am J Prev Med. 2006;31:72–79
  5. de Diego C, Vila-Córcoles A, Ochoa O, et al. EPIVAC Study Group Effects of annual influenza vaccination on winter mortality in elderly people with chronic heart disease. Eur Heart J. 2009;30:209–216Epub 2008 Nov 8
  6. Jackson LA, Janoff EN. Pneumococcal vaccination of elderly adults: new paradigms for protection. Clin Infect Dis. 2008;47:1328–1338
  7. Johnstone J, Marrie TJ, Eurich DT, Majumdar SR. Effect of pneumococcal vaccination in hospitalized adults with community-acquired pneumonia. Arch Intern Med. 2008;168:666–667

PII: S0002-9343(09)00053-9

doi:10.1016/j.amjmed.2008.12.015

The American Journal of Medicine
Volume 122, Issue 5 , Page e15, May 2009

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