Dublin and colleagues (1) found that statin use increased
the risk of pneumonia among healthy, community dwelling older people (odds
ratio 1.26, 95% confidence interval 1.01 to 1.56). Among the possible
biological mechanisms of this detrimental action, they suggested that the
well known immunomodulatory action of statins (2) might exert a
significative role. We fully agree, and further suggest other mechanisms.
In the study of Dublin and colleagues (1), swallowing disorder were
increased in statin users. It is highly plausible that this disorder might
be related to a deminished cough mechanism due to statin related muscle
adverse effects (3). Indeed, it has been shown that cough, a well-
characterised side-effect of ACE inhibitors, could be of some benefit in
this setting in that it can decrease the risk of aspiration pneumonia in
certain patients (4). Of note, it was found that cholesterol had graded
inverse associations with some respiratory diseases, tending to be
stronger in older individuals (5).
Therefore, in clinical practice, caution is needed when giving statins for
primary cardiovascular prevention to older people.
1. Dublin S, Jackson ML, Nelson JC, Weiss NS, Larson EB,
Jackson LA. Statin use and risk of community acquired pneumonia in older
people: population based case-control study. BMJ. 2009 Jun 16;338:b2137.
doi: 10.1136/bmj.b2137.
2. Goldstein MR, Mascitelli L, Pezzetta F. The double-edged
sword of statin immunomodulation. Int J Cardiol 2009;135:128-30.
3. Joy TR, Hegele RA. Narrative review: statin-related
myopathy. Ann Intern Med 2009;150:858-68.
4. Iribarren C, Jacobs DR Jr, Sidney S, Claxton AJ, Gross
MD, Sadler M, et al. Serum total cholesterol and risk of hospitalization,
and death from respiratory disease. Int J Epidemiol 1997;26:1191-
202.
5. Rafailidis PI, Matthaiou DK, Varbobitis I, Falagas ME.
Use of ACE inhibitors and risk of community-acquired pneumonia: a review.
Eur J Clin Pharmacol 2008;64:565-73.
Competing interests:
None declared
Competing interests:
No competing interests
23 June 2009
Luca Mascitelli
Medical Officer
Francesca Pezzetta MD, Tolmezzo, Italy; Mark R Goldstein, Bonita Springs, FL, USA
Rapid Response:
Statin use and risk of pneumonia.
Dublin and colleagues (1) found that statin use increased
the risk of pneumonia among healthy, community dwelling older people (odds
ratio 1.26, 95% confidence interval 1.01 to 1.56). Among the possible
biological mechanisms of this detrimental action, they suggested that the
well known immunomodulatory action of statins (2) might exert a
significative role. We fully agree, and further suggest other mechanisms.
In the study of Dublin and colleagues (1), swallowing disorder were
increased in statin users. It is highly plausible that this disorder might
be related to a deminished cough mechanism due to statin related muscle
adverse effects (3). Indeed, it has been shown that cough, a well-
characterised side-effect of ACE inhibitors, could be of some benefit in
this setting in that it can decrease the risk of aspiration pneumonia in
certain patients (4). Of note, it was found that cholesterol had graded
inverse associations with some respiratory diseases, tending to be
stronger in older individuals (5).
Therefore, in clinical practice, caution is needed when giving statins for
primary cardiovascular prevention to older people.
1. Dublin S, Jackson ML, Nelson JC, Weiss NS, Larson EB,
Jackson LA. Statin use and risk of community acquired pneumonia in older
people: population based case-control study. BMJ. 2009 Jun 16;338:b2137.
doi: 10.1136/bmj.b2137.
2. Goldstein MR, Mascitelli L, Pezzetta F. The double-edged
sword of statin immunomodulation. Int J Cardiol 2009;135:128-30.
3. Joy TR, Hegele RA. Narrative review: statin-related
myopathy. Ann Intern Med 2009;150:858-68.
4. Iribarren C, Jacobs DR Jr, Sidney S, Claxton AJ, Gross
MD, Sadler M, et al. Serum total cholesterol and risk of hospitalization,
and death from respiratory disease. Int J Epidemiol 1997;26:1191-
202.
5. Rafailidis PI, Matthaiou DK, Varbobitis I, Falagas ME.
Use of ACE inhibitors and risk of community-acquired pneumonia: a review.
Eur J Clin Pharmacol 2008;64:565-73.
Competing interests:
None declared
Competing interests: No competing interests