Published 16 June 2009, doi:10.1136/bmj.b2137
Cite this as: BMJ 2009;338:b2137

Research

Statin use and risk of community acquired pneumonia in older people: population based case-control study

¹ Group Health Center for Health Studies, 1730 Minor Avenue, Suite 1600, Seattle WA 98101-1448, USA, ² Department of Epidemiology, University of Washington, Seattle, WA 98195, ³ Department of Biostatistics, University of Washington, ⁴ Department of Medicine, University of Washington, ⁵ Department of Health Services, University of Washington

Objective To test the hypothesis that hydroxymethyl glutaryl coenzyme A reductase inhibitors (statins) may decrease the risk of community acquired pneumonia.

Design Population based case-control study.

Setting Group Health, a large integrated healthcare delivery system.

Population Immunocompetent, community dwelling Group Health members aged 65 to 94; two matched controls for each case with pneumonia. Information on comorbid illnesses and functional and cognitive status, potential confounders of the association between statin use and risk of pneumonia, came from medical record review and computerised pharmacy data.

Main outcome measure Adjusted estimates of risk of pneumonia in relation to current statin use.

Results 1125 validated cases of pneumonia and 2235 matched controls were identified. Compared with controls, cases were more likely to have chronic lung and heart disease, especially severe disease, and functional or cognitive impairment. Current statin use was present in 16.1% (181/1125) of cases and 14.6% (327/2235) of controls (adjusted odds ratio 1.26, 95% confidence interval 1.01 to 1.56). Among cases admitted to hospital and matched controls, current statin use was present in 17.2% (68/395) of cases and 14.2% (112/788) of controls (adjusted odds ratio 1.61, 1.08 to 2.39, compared with non-use). In people in whom statins were indicated for secondary prevention, the adjusted odds ratio for risk of pneumonia in relation to current statin use was 1.25 (0.94 to 1.67); in those with no such indication, it was 0.81 (0.46 to 1.42).

Conclusions Statin use was not associated with decreased risk of pneumonia among immunocompetent, community dwelling older people. Findings of previous studies may reflect "healthy user" bias.

© Dublin et al 2009
This is an open-access article distributed under the terms of the Creative Commons Attribution Non-commercial License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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Rapid Responses:

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The strange case of the disappearing gastroprotectors

Ezgi Gulmez, et al.
bmj.com, 19 Jun 2009 [Full text]

Statin use and risk of pneumonia.

Luca Mascitelli, et al.
bmj.com, 23 Jun 2009 [Full text]

Re: The strange case of the disappearing gastroprotectors

Sascha Dublin, et al.
bmj.com, 28 Jun 2009 [Full text]

We are not expecting statins to prevent pneumonia.

Konosuke Morimoto, et al.
bmj.com, 28 Jun 2009 [Full text]

Re: We are not expecting statins to prevent pneumonia.

Sascha Dublin, et al.
bmj.com, 8 Jul 2009 [Full text]

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