Do outpatient statins and ACEIs/ARBs have synergistic effects in reducing the risk of pneumonia? A population-based case-control study

Abstract

Whether statins and an angiotensin-converting enzyme inhibitors (ACEIs) / angiotensin receptor blockors (ARBs) are associated with reduced risks of infection events is still inconclusive. This study aimed to explore the risk of hospitalization for pneumonia among patients who had received treatment with ACEIs/ARBs and/or statins using a population-based dataset. This study included 19,281 patients as cases who were hospitalized for pneumonia and 19,281 controls. We used a logistic regression to compute the odds ratio (OR) and 95% confidence interval (CI) for having previously used statins or an ACEI/ ARB between patients who were hospitalized for pneumonia treatment and controls. We found there were significant associations between hospitalization for pneumonia and statin-only users (p<0.001), ACEI/ARB-only users (p<0.001), and statin and ACEI/ARB users (p<0.001). The logistic regression analysis suggested that statin-only users (adjusted OR = 0.38, 95% CI = 0.34~0.43), ACEI/ARB-only users (adjusted OR = 0.86, 95% CI = 0.82~0.91), and statin and ACEI/ARB users (adjusted OR = 0.47, 95% CI = 0.44~0.50) were all less likely to be hospitalized for pneumonia treatment than were non-users. Furthermore, we found that statin-only users (adjusted OR = 0.44, 95% CI = 0.40~0.50) and statin and ACEI/ARB users (adjusted OR = 0.55, 95% CI = 0.52~0.58) were less likely to be hospitalized for pneumonia treatment compared to ACEI-only users. However, combined statin and ACEI/ARB users (adjusted OR = 1.24, 95% CI = 1.10~1.40) were more likely to have been hospitalized for pneumonia treatment compared to statin-only users. Although we found use of both statins and ACEI/ARB were significantly associated with a lower risk of pneumonia, the combination of the two medications did not provide additional protection against pneumonia risk.

Hypertension, the renin–angiotensin system, and the risk of lower respiratory tract infections and lung injury: implications for COVID-19

“…18 In addition, ACEIs and ARBs have been also previously linked to reduced mortality in patients with CAP 19 and a reduced risk for CAP requiring hospitalization. 20 In summary, available studies do not provide sound evidence that hypertension is an independent risk factor for LRTI/CAP. However, they indicate that hypertension contributes to the increased occurrence of incident cardiovascular events in these patients, in agreement with the well-established risk associated with hypertension.…”

Pathophysiology and pharmacological management of pulmonary and cardiovascular features of COVID-19

“…Concomitantly, recent studies have suggested that the clinical benefits associated with these drugs may be attributed to their role in the upregulation of ACE2 expression and activity [ 120 , 125 ]. Clinical studies using a large cohort of patients have shown that patients treated with ACE inhibitors and ARBs had a lower risk of developing pneumonia [ 126 ] and ARDS [ 34 ]. From a cardiopulmonary perspective, no clear indication or data is supporting the benefits of discontinuing or holding the use of RAS antagonists in these patients.…”

<p>Effect of Statins on the Risk of Poststroke Pneumonia: National Population-Based Cohort Study</p>

“…The conflicting data among studies might be related to heterogeneous regimens, timing of treatment with statins, variability in definition of pneumonia, and study duration. 56 Patients with acute ischemic stroke in the present study, who were particularly at great risk for pneumonia, may be more likely to benefit from treatment with statins than the general population. To date, no large randomized clinical study has been conducted evaluating the effect of statins on the development of pneumonia as the primary outcome measure.…”