The role of statins in prevention and treatment of community acquired pneumonia: a systematic review and meta-analysis.
BACKGROUND
Emerging epidemiological evidence suggests that statins may reduce the risk of community-acquired pneumonia (CAP) and its complications.


OBJECTIVE
Performed a systematic review to address the role of statins in the prevention or treatment of CAP.


METHODS
Ovid MEDLINE, Cochrane, EMBASE, ISI Web of Science, and Scopus from inception through December 2011 were searched for randomized clinical trials, cohort and case-control studies.


METHODS
Two authors independently reviewed studies that examined the role of statins in CAP.


METHODS
Data about study characteristics, adjusted effect-estimates and quality characteristics was extracted.


RESULTS
Eighteen studies corresponding to 21 effect-estimates (eight and 13 of which addressed the preventive and therapeutic roles of statins, respectively) were included. All studies were of good methodological quality. Random-effects meta-analyses of adjusted effect-estimates were used. Statins were associated with a lower risk of CAP, 0.84 (95% CI, 0.74-0.95), I(2) = 90.5% and a lower short-term mortality in patients with CAP, 0.68 (95% CI, 0.59-0.78), I(2) = 75.7%. Meta-regression did not identify sources of heterogeneity. A funnel plot suggested publication bias in the treatment group, which was adjusted by a novel regression method with a resultant effect-estimate of 0.85 (95% CI, 0.77-0.93). Sensitivity analyses using the rule-out approach showed that it is unlikely that the results were due to an unmeasured confounder.


CONCLUSIONS
Our meta-analysis reveals a beneficial role of statins for the risk of development and mortality associated with CAP. However, the results constitute very low quality evidence as per the GRADE framework due to observational study design, heterogeneity and publication bias.
Department of Internal Medicine, University of Toledo Medical Center, Toledo, Ohio, United States of America.
Abdur Rahman
AR
Khan
Muhammad
M
Riaz
Aref A
AA
Bin Abdulhak
Mohamad A
MA
Al-Tannir
Musa A
MA
Garbati
Patricia J
PJ
Erwin
Larry M
LM
Baddour
Imad M
IM
Tleyjeh
D017714:Community-Acquired Infections / Q000188:drug therapy* / Q000517:prevention & control*; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000494:pharmacology* / Q000627:therapeutic use*; D011014:Pneumonia / Q000188:drug therapy* / Q000517:prevention & control*
D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors