Population-based study of statins, angiotensin II receptor blockers, and angiotensin-converting enzyme inhibitors on pneumonia-related outcomes

Eric M. Mortensen, Brandy Nakashima, John Cornell, Laurel A. Copeland, Mary Jo Pugh, Antonio Anzueto, Chester Good, Marcos I. Restrepo, John R. Downs, Christopher R. Frei, Michael J. Fine

Research output: Contribution to journalArticle

66 Citations (Scopus)

Abstract

Background.Studies suggest that statins and angiotensin-converting enzyme (ACE) inhibitors might be beneficial for the treatment of infections. Our purpose was to examine the association of statin, ACE inhibitor, and angiotensin II receptor blocker (ARB) use with pneumonia-related outcomes.Methods.We conducted a retrospective cohort study using Department of Veterans Affairs data of patients aged ≥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 [OR], 0.74; 95 confidence interval [CI],. 68-.82) and mechanical ventilation (OR, 0.81; 95 CI,. 70-.94), and inpatient use with decreased mortality (OR, 0.68; 95 CI,. 59-.78) and mechanical ventilation (OR, 0.68; 95 CI,. 60-.90). Prior (OR, 0.88; 95 CI,. 80-.97) and inpatient (OR, 0.58; 95 CI,. 48-.69) ACE inhibitor use was associated with decreased mortality. Prior (OR, 0.73; 95 CI,. 58-.92) and inpatient ARB use (OR, 0.47; 95 CI,. 30-.72) was only associated with decreased mortality. Use of all 3 medications was associated with reduced length of stay.Conclusions.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.

Original languageEnglish (US)
Pages (from-to)1466-1473
Number of pages8
JournalClinical Infectious Diseases
Volume55
Issue number11
DOIs
StatePublished - Dec 1 2012

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Hydroxymethylglutaryl-CoA Reductase Inhibitors
Angiotensin Receptor Antagonists
Angiotensin-Converting Enzyme Inhibitors
Pneumonia
Odds Ratio
Confidence Intervals
Population
Mortality
Inpatients
Artificial Respiration
Propensity Score
Veterans
Infection
Action Potentials
Length of Stay
Cohort Studies
Randomized Controlled Trials
Retrospective Studies

ASJC Scopus subject areas

  • Infectious Diseases
  • Microbiology (medical)

Cite this

Population-based study of statins, angiotensin II receptor blockers, and angiotensin-converting enzyme inhibitors on pneumonia-related outcomes. / Mortensen, Eric M.; Nakashima, Brandy; Cornell, John; Copeland, Laurel A.; Pugh, Mary Jo; Anzueto, Antonio; Good, Chester; Restrepo, Marcos I.; Downs, John R.; Frei, Christopher R.; Fine, Michael J.

In: Clinical Infectious Diseases, Vol. 55, No. 11, 01.12.2012, p. 1466-1473.

Research output: Contribution to journalArticle

Mortensen, EM, Nakashima, B, Cornell, J, Copeland, LA, Pugh, MJ, Anzueto, A, Good, C, Restrepo, MI, Downs, JR, Frei, CR & Fine, MJ 2012, 'Population-based study of statins, angiotensin II receptor blockers, and angiotensin-converting enzyme inhibitors on pneumonia-related outcomes', Clinical Infectious Diseases, vol. 55, no. 11, pp. 1466-1473. https://doi.org/10.1093/cid/cis733
Mortensen, Eric M. ; Nakashima, Brandy ; Cornell, John ; Copeland, Laurel A. ; Pugh, Mary Jo ; Anzueto, Antonio ; Good, Chester ; Restrepo, Marcos I. ; Downs, John R. ; Frei, Christopher R. ; Fine, Michael J. / Population-based study of statins, angiotensin II receptor blockers, and angiotensin-converting enzyme inhibitors on pneumonia-related outcomes. In: Clinical Infectious Diseases. 2012 ; Vol. 55, No. 11. pp. 1466-1473.
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abstract = "Background.Studies suggest that statins and angiotensin-converting enzyme (ACE) inhibitors might be beneficial for the treatment of infections. Our purpose was to examine the association of statin, ACE inhibitor, and angiotensin II receptor blocker (ARB) use with pneumonia-related outcomes.Methods.We conducted a retrospective cohort study using Department of Veterans Affairs data of patients aged ≥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 [OR], 0.74; 95 confidence interval [CI],. 68-.82) and mechanical ventilation (OR, 0.81; 95 CI,. 70-.94), and inpatient use with decreased mortality (OR, 0.68; 95 CI,. 59-.78) and mechanical ventilation (OR, 0.68; 95 CI,. 60-.90). Prior (OR, 0.88; 95 CI,. 80-.97) and inpatient (OR, 0.58; 95 CI,. 48-.69) ACE inhibitor use was associated with decreased mortality. Prior (OR, 0.73; 95 CI,. 58-.92) and inpatient ARB use (OR, 0.47; 95 CI,. 30-.72) was only associated with decreased mortality. Use of all 3 medications was associated with reduced length of stay.Conclusions.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.",
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AU - Mortensen, Eric M.

AU - Nakashima, Brandy

AU - Cornell, John

AU - Copeland, Laurel A.

AU - Pugh, Mary Jo

AU - Anzueto, Antonio

AU - Good, Chester

AU - Restrepo, Marcos I.

AU - Downs, John R.

AU - Frei, Christopher R.

AU - Fine, Michael J.

PY - 2012/12/1

Y1 - 2012/12/1

N2 - Background.Studies suggest that statins and angiotensin-converting enzyme (ACE) inhibitors might be beneficial for the treatment of infections. Our purpose was to examine the association of statin, ACE inhibitor, and angiotensin II receptor blocker (ARB) use with pneumonia-related outcomes.Methods.We conducted a retrospective cohort study using Department of Veterans Affairs data of patients aged ≥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 [OR], 0.74; 95 confidence interval [CI],. 68-.82) and mechanical ventilation (OR, 0.81; 95 CI,. 70-.94), and inpatient use with decreased mortality (OR, 0.68; 95 CI,. 59-.78) and mechanical ventilation (OR, 0.68; 95 CI,. 60-.90). Prior (OR, 0.88; 95 CI,. 80-.97) and inpatient (OR, 0.58; 95 CI,. 48-.69) ACE inhibitor use was associated with decreased mortality. Prior (OR, 0.73; 95 CI,. 58-.92) and inpatient ARB use (OR, 0.47; 95 CI,. 30-.72) was only associated with decreased mortality. Use of all 3 medications was associated with reduced length of stay.Conclusions.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.

AB - Background.Studies suggest that statins and angiotensin-converting enzyme (ACE) inhibitors might be beneficial for the treatment of infections. Our purpose was to examine the association of statin, ACE inhibitor, and angiotensin II receptor blocker (ARB) use with pneumonia-related outcomes.Methods.We conducted a retrospective cohort study using Department of Veterans Affairs data of patients aged ≥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 [OR], 0.74; 95 confidence interval [CI],. 68-.82) and mechanical ventilation (OR, 0.81; 95 CI,. 70-.94), and inpatient use with decreased mortality (OR, 0.68; 95 CI,. 59-.78) and mechanical ventilation (OR, 0.68; 95 CI,. 60-.90). Prior (OR, 0.88; 95 CI,. 80-.97) and inpatient (OR, 0.58; 95 CI,. 48-.69) ACE inhibitor use was associated with decreased mortality. Prior (OR, 0.73; 95 CI,. 58-.92) and inpatient ARB use (OR, 0.47; 95 CI,. 30-.72) was only associated with decreased mortality. Use of all 3 medications was associated with reduced length of stay.Conclusions.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.

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DO - 10.1093/cid/cis733

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