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they conclude that although prior statin use appears to lower mortality following pneumonia, the effect is substantially diminished following subgroup stratification and adjustment for confounding covariates. We note that an important exception to this conclusion is observed in smokers (current and former), where mortality reduction from statin use was 37% (and unaffected by adjustment).
We and others have shown that, among smokers, COPD confers a 3- to 5-fold greater risk of death from both cardiac and respiratory complications of smoking, attributed in large part to the pulmonary-systemic inflammation underlying COPD.
(mortality reduction from pneumonia in ever smokers) and suggest that a randomized, controlled trial target COPD. Stratification by COPD status was not examined in their study, as spirometry is not routinely performed in pneumonia, or in smokers generally (explaining why 50%-80% of COPD goes undiagnosed). We conclude that subgroups of the population in which systemic inflammation is common (eg, COPD) are likely to benefit most from statin use.
Is statin use associated with reduced mortality after pneumonia? A systematic review and meta-analysis.
We thank Young and Hopkins1 for their thoughtful letter. As a principal aim of our study was to inform the design of a randomized-controlled trial, we are pleased our analysis is being used for this purpose.2