Do statins reduce the risk of infection?

The linked meta-analysis of randomised trials by van den Hoek and colleagues (doi:10.1136/bmj.d7281) assesses whether the potential of statins to lower the risk of infections noted in observational studies is causal.1 Data were pooled from 11 eligible clinical trials of statins relative to placebo, all of which had at least 100 patients who were treated for at least a year. The trials studied 30 947 patients, of whom 4655 reported an infection—2368 in the statin group and 2287 in the placebo group. This new analysis—the strongest to date on this subject—showed no benefit of statins on the occurrence of infection (relative risk 1.0) or death as a result of infection.

These findings might seem surprising. They are in stark contrast to the favourable associations—greater than 60% reductions for some infection outcomes—reported in pooled analyses of mainly observational studies,2 which were also supported by mechanisms by which statins could theoretically reduce infection.

However, observational studies have reported improvements in other outcomes with statins (including bone health, cognition and Alzheimer’s …