The impact of statins, ACE inhibitors and gastric acid suppressants on pneumonia mortality in a UK general practice population cohort.
BACKGROUND
Pneumonia is a common diagnosis in general practice in the United Kingdom. Previous studies suggest that commonly prescribed drugs in general practice may influence pneumonia mortality.


OBJECTIVE
We investigated whether statins, angiotensin converting enzyme inhibitors (ACEIs), proton pump inhibitors (PPIs) and histamine-2-receptor antagonists (H(2)RAs) have an impact on short-term and long-term mortality in pneumonia cases.


METHODS
Population-based cohort study SETTTING: United Kingdom


METHODS
Data on 3681 pneumonia cases above the age of 40 years were obtained from a comprehensive database called the health improvement network (THIN) which has computerised medical records from 300 general practice surgeries in the United Kingdom. We used Cox regression for our analyses.


RESULTS
Current statin use was associated with a 67% decrease in 30-day mortality (adj. HR: 0.33, 95% CI: 0.19-0.58) and a 55% decrease in long-term mortality (adj. HR: 0.45, 95% CI: 0.32-0.62) over a median follow-up of 2.8 years as compared to no-use. Current ACEI use decreased the 30-day mortality risk by nearly 38% as compared to no-use (adj. HR: 0.62, 95% CI: 0.47-0.82) but was not associated with long-term mortality. No significant impact on mortality was observed for either gastric acid suppressant.


CONCLUSIONS
The use of statins is associated with a lower risk of short- and long-term mortality following pneumonia whereas the use of ACEIs is associated with a decreased mortality risk only in the short-term.
Myles
Puja R
PR
Division of Epidemiology & Public Health, University of Nottingham, Clinical Sciences Building, City Hospital, Nottingham NG5 1PB, UK. puja.myles@nottingham.ac.uk
Hubbard
Richard B
RB
Gibson
Jack E
JE
Pogson
Zara
Z
Smith
Christopher J P
CJ
McKeever
Tricia M
TM
D000328:Adult; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use*; D015331:Cohort Studies; D005194:Family Practice / Q000706:statistics & numerical data*; D005260:Female; D006635:Histamine H2 Antagonists / Q000627:therapeutic use*; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use*; D053208:Kaplan-Meier Estimate; D008297:Male; D011014:Pneumonia / Q000401:mortality* / Q000517:prevention & control; D011159:Population Surveillance; D011379:Prognosis; D016016:Proportional Hazards Models; D054328:Proton Pump Inhibitors / Q000627:therapeutic use*; D018570:Risk Assessment; D013997:Time Factors; D006113:United Kingdom / Q000453:epidemiology
D000806:Angiotensin-Converting Enzyme Inhibitors; D006635:Histamine H2 Antagonists; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D054328:Proton Pump Inhibitors