Prior use of both a statin and ARB is associated with lower mortality for patients hospitalized with pneumonia

Abstract

Introduction: Studies suggest that statins and/or angiotensin receptor blockers (ARBs) might be beneficial for infections. However there is little information on whether combination therapy with statins and ARBs might be associated with improved outcomes. Our purpose was to examine the association of prior outpatient receipt of statins and ARBs on 30-day mortality for patients hospitalized with pneumonia. Methods: We conducted a retrospective cohort study using national Department of Veterans Affairs data of patients > 65 years hospitalized with pneumonia over a 5-year period. We used multilevel regression models to examine the association of either statins, ARBs, or both statins and ARBs, after controlling for sociodemographics, comorbid conditions, prior outpatient health care utilization, and severity of illness, as well as for the admitting hospital. Results: We identified 50,119 patients who meet the inclusion criteria, and 30.0% received statins only, 3.9% received only ARBs, and 2.1% receive both ARBs and statins. Overall, mortality at 30-days was 14.3%. In the adjusted models, prior statin use only (odds ratio 0.63, 95% confidence interval 0.57- 0.69), prior ARB use only (0.69, 0.54- 088), and prior statin and ARB combination use (0.40, 95% 0.31-0.52) were all associated with lower 30-day mortality. Discussion: Prior receipt of both a statin and ARB was associated with significantly lower mortality as compared to statins or ARBs only. Randomized controlled trials are needed to examine potential mechanisms of action and whether acute initiation at the time of presentation of statins and ARBs for those with these infections may be beneficial.