1. Statin treatment and reduced risk of pneumonia in patients with diabetes EMW van de Garde, E Hak, P c Souverein, AW Hoes, JMM van den Bosch, HGM Leufkens Thorax 2006: 61: 957~961 R1 Song Se-bin

2. Background  Community acquired pneumonia -> top 10 leading causes of death in the elderly  Pts with diabetes type I or 2 -> high risk for lower respiratory tract inf. and Cx.  Statin in Recent in vitro studies ->different immunomodulatory effects ->modulate lipopolysaccharide ->modulate pul. Inflammation and bacterial infection  Recent prognostic studies ->previous Tx. with statins ->decreased rates of severe sepsis and mortality in Pts. admitted to hospital with pneumonia

3. Method Data from the United Kingdom GPRD 142,175 pts. With diabetes(type 1 and 2) From 1 June 1987 to 21 January 2001 >18 yrs with a first medical attendance for CAP Index date-> date of Pn.diagnosis Control group -> randomly selected from diabetic pts without Pn. matched for sex, age, general practice, index date

4. Statin group ->prescription for atorvastatin, cervastain, fluvastatin, pravastatin, simvastatin -> current and past statin users Potential confounders -> cardiovascular disease, pul. Disease, alchoholism smoking status, body mass indes, past Med Hx vaccination, immunosuppressive drugs, or oral glucocorticoids, gastric acid suppressing drug Statistical analysis odds ratios(OR) with 95% confidence intervals multivariate analysis

5. Results

7. Pn. With diabetes type 1 or 2(n =4719) Pneumococcal pneumonia->271 명 Other bacterial pneumonia-> 46 명 Bronchopneumonia with unspecified->2050 명 Unspecifed pneumonia-> 2291 명

9. Adjusted Odd ratio for the different statins statinOdd ratio Atorvastatin(n=57)0.57 Cerivastatin(n=17)0.48 Fluvastatin(n=228)0.37 Pravastatin(n=47)0.36 Simvastatin(n=228)0.52

11. Conclusion

12. Treatment with statins is associated with a considerably decreased risk of pneumonia in diabetic pts. Statins may also influence bacterial respiratory infections broaden the indications for these drugs

13. Discussion

14. Statins Considerably reduced risk of pneumonia lipid lowering effect + immunomodulatory effect + anti-inflammatory properties In vitro study -> normalising the inflammatory response in resp.bacterial inf. first study to examine the possible prophylactic effect of statins about incidence of pneumonia experimental study by Fessler et al. individual statins-> less different odd ratio other factor-> not substantially change the risk estimates applicable to the general population

15. Limitation misclassification of cases of pneumonia -> misclassification due to incorrect coding -> but independent of statin use Misclassification of exposure to statin Tx. -> Pt. non-compliance -> underestimation of the association between statin use and the occurrence of pn. Healthy user effect->confounding Cannot rule out confounding of unmeasured factors No suggesting that statins should be given to all diabetic patients to prevent pneumonia