Statins Reduce Deaths in Patients Hospitalized for Influenza

A preliminary study in the Journal of Infectious Diseases finds that patients hospitalized with influenza were less likely to die if they were taking a statin, compared with their peers who weren't taking one of the drugs. The effect held even after adjusting for heart disease.
But it's far too soon to consider adding statins to the existing anti-flu armamentarium, the authors stated.
"At this point, statins should not become the standard of care for people hospitalized with the flu," cautioned study co-author Dr. Ann Thomas, a public health physician with the Oregon Public Health Division in Portland. "We would like to see more studies, [and] I think it would be worthwhile to do these studies."


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Statins have piqued the interest of virologists and others because they may have anti-inflammatory properties that might mitigate the damage from the influenza virus.
"There have been a couple of studies that have found an apparent association between statins and improved mortality in patients who've had sepsis [blood infections], who've had community-acquired pneumonia," said Dr. Bruce Hirsch, an attending physician in infectious diseases at North Shore University Hospital in Manhasset, NY.
This is the first observational study to investigate a possible relationship between statins and deaths from the flu.


In conclusion, the authors stress the need for randomized controlled trials to help sort out the value of statins in managing influenza. However, they continue, "[d]espite [these] limitations and the need for [randomized controlled trials] before statins can be widely promoted for the treatment of influenza, our findings suggest that statins are a promising area of exploration and could provide a useful adjunct to antiviral medications and vaccine, particularly in settings where circulating influenza virus strains are not susceptible to antiviral medications or vaccine is in short supply or not well matched to circulating viruses."


In an accompanying editorial , Edward Walsh, MD, from the Infectious Diseases Division, Rochester General Hospital, New York, notes that despite increasing uptake of influenza vaccine among the highest-risk groups, morbidity and mortality from influenza continue to rise in the United States.


"This paradox has stimulated a heated debate regarding the true efficacy of influenza vaccination in older persons," he writes. Some investigators have suggested that efficacy of the vaccine may be only negligible in older people, he notes, adding, " even the most optimistic proponents of immunization concede that the current licensed standard dose of inactivated vaccine is less immunogenic and protective in older persons than in young healthy persons."


He commends Dr. Vandermeer and colleagues on their present research and echoes their call for randomized controlled trials aimed at more precisely evaluating how statins may affect influenza.


"Although not the first study to note such an effect, this article adds significantly to the slowly accumulating evidence that statins may reduce the substantial annual morbidity and mortality from influenza," Dr. Walsh writes.


Other experts concurred with that view.


"This is the largest and most carefully controlled study so far to look at the association of ongoing use of statins and mortality among patients with influenza," said Andrew Pavia, MD, FAAP, FIDSA, chief, Division of Pediatric Infectious Diseases, University of Utah, Salt Lake City, in an interview with Medscape Medical News. "The authors tried to carefully control for other potential explanations, and statin use still seems to be associated with decreased mortality. It adds to earlier, less-powerful studies that showed similar results."


Dr. Pavia pointed out that statins are known to have complex effects on inflammation, and that inflammation plays an important role in severe influenza, "so it is possible that there is a real beneficial effect of long-term statin use in influenza," he noted.


However, he continued, "[w]e need to be very cautious in trying to interpret what this means for patient care." For example, he pointed out, none of the studies conducted so far have addressed the question of whether initiating statin therapy during a bout of influenza would have any effect on the illness.


Given that unanswered question, along with others, Dr. Pavia said clinicians should not be using statins solely for their possible effect on influenza.


Even so, he concluded, "I think we have enough data now to seriously consider investing in a study where patients with influenza who are getting standard care including antivirals are randomized to receive a statin or placebo. Even more importantly, we need to develop a range of treatments that can reduce the death rate from severe influenza."


This work was supported by the Emerging Infections Program Cooperative Agreement between the 10 study sites and the Centers for Disease Control and Prevention. One of the authors has been an occasional consultant to Sanofi Pasteur, Novartis, Pfizer, Dynavax, and GlaxoSmithKline, and is a member of the Data Safety Monitoring Board for experimental vaccine studies for Merck. The other authors have disclosed no relevant financial relationships. Dr. Walsh serves on a Laboratory Quality Review Panel for Alnylam Pharmaceuticals. Dr. Pavia has disclosed no relevant financial relationships.