The newswires are carrying a story that the journal, Chest, is about to publish a retrospective study of influenza mortality and statin use. As happens more and more frequently, press reports are appearing prior to the actual article, so I haven't read it yet. This is very irritating. The whole press embargo system is irritating, in fact, and should be deep-sixed (Full discolosure: I frequently get advance copies of embargoed articles and I honor the dates. But I don't think journals should do it. It serves no useful purpose.).
The embargo issue aside, here is what the press is saying:
People who use statin drugs are less likely to die of influenza and chronic bronchitis, according to a study that shows yet another unexpected benefit of the cholesterol-lowering medications.Their study of more than 76,000 people showed that those who had taken statins for at least 90 days had a much lower risk of dying from chronic obstructive pulmonary disease or COPD, the technical name for emphysema and chronic bronchitis.
Patients on statins also had a lower risk of dying from influenza or pneumonia, the researchers reported Monday.
[snip]
The new study supports a theory proposed last year that statin drugs might help patients with H5N1 avian influenza, which some studies suggest kills by causing an immune system overreaction called a cytokine storm.
Floyd Frost of the Lovelace Respiratory Research Institute in Albuquerque, New Mexico, and colleagues analyzed their institute's database of medical records from several health maintenance organizations.
They looked at incidence of influenza and pneumonia and of COPD [chronic obstructive pulmonary disease], and then cross-checked to see which patients were also taking statins.
"This study found a dramatically reduced risk of death from COPD among statin users and a significantly reduced risk of death from influenza/pneumonia," the researchers wrote in their report, published in the journal Chest.
"These findings suggest that moderate-dose statin use reduces the risk of influenza/pneumonia death and strongly suggest that statins reduce the risk of COPD death." (CNN)
We've posted on this before (see here and here). Some statins have now gone off patent and are available in generic form. They are among the highest volume drugs and supplies are plentiful, so if they are truly protective of the most virulent outcomes of H5N1 infection this is good news.
It isn't at all clear how statins work to protect against cytokine storm (if in fact they do). David Fedson, who has done more than anyone else to alert the flu community to the potential of this class of drugs in a pandemic, has reviewed the literature (abstract here). We know some virulent strains of H5N1 can interfere with cytokine signalling in the immune system (parts of the nonstructural protein 1 [NS1] inhibit the action of interferons and tumor necrosis factor in the test tube) and there is a marked elaboration of proinflammatory cytokines in patients with H5N1 infection. But the cytokine signalling system is complicated and it can make a big difference if you inhibit one of the interferons early in an infection or later on. The advantage of statins is that they are taken continuously for other purposes (cholesterol lowering) and are relatively non-toxic. This means that whatever their effects on cytokines the timing can be easily duplicated.prophylactically.
Not a silver bullet. But like everything else connected with this nasty virus, we'll take whatever we can get.
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Yeah, but.
The study says people who've been on statins for 90 days. If you're already taking statins, great. But if you're not, what's the benefit. Do you foresee the will and momentum by governments to recommend that the general public go on prophylactic statins once, say, WHO declares phase 4?
Or do you think that statins could be used more reactively than proactively by administering them to people once diagnosed with panflu as a means of regulating the cytokine storm?
I'll tell you this. I've been blowing off getting my cholesterol tested, but I'm doing it now. And I'm drinking a quart of half-and-half before I go! ;)
Nancy: The 90 days was the criterion used in the study but it doesn't mean that 90 days is required. It could be (and almost certainly is) less. My cholesterol went from 240 to 170 in 30 days, and although we don't know the mechanism is the same for lowering cholesterol and protecting from cytokine storm, I would surmise it is, so the required time is probably less than 30 days. How soon it works or if taken when you feel sick we don't know.
Thanks for clarifying Revere.
revere,
thank you for bringing this to our attention again. The most irritating thing about the possible use of statins in a pandemic, is the fact that no institution has taken on a leadership role in co-ordinating research, so we can get the answer to the question one way or the other: whether statins are likely to work to reduce mortality in a pandemic, and how specifically should we use them.
I was at a conference with some of the top flu scientists recently, including a fair number from the WHO Pandemic Task Force. One speaker was commenting on alternatives to anti-virals, and statins topped the list. However, neither the speaker nor any of those present could shed any light on whether someone is actually working on this!
This is one of those things where everyone thinks is a good idea but all assume that someone else is working on it, or that it's not their problem, or it's not their area of expertise, among the various responses that I've heard. Fedson, as you said, is the lone voice among the experts. Since he is retired, he cannot personally bring any institution on board. Therein lies the current difficulty.
For less than a dollar per week's treatment course, even if the reduction in mortality is modest, we are still talking about potentially millions of lives saved all over the world. I find it hard to believe that the collective wisdom of the scientific community cannot even overcome the logistics (not the science, not yet, until we've overcome the logistics) of STARTING the research into statin use in a pandemic.
If and when a pandemic happens, some people are likely to use statins whether there is sufficient evidence of efficacy or not. If when it's all over, we find that they were actually efficacious, this will be one of the biggest black marks on science in all of human history.
Associated Press: Some time in the future.
People who use statin drugs are less likely to die of avian flu, according to a study that shows yet another unexpected benefit of the cholesterol-lowering medications.
Their study of more than 760,000 people showed that those who had taken statins for at least 10 days had a much lower risk of dying from pandemic avian flu.
Patients on statins suprisingly also had a lower risk of dying from stroke and cancer, the researchers reported Monday.
"These findings suggest that moderate-dose statin use reduces the risk of avian flu death and strongly suggest that statins reduce the risk of stroke and cancer death." (CNN)
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My first point of the cheeky modification is that the first study is retrospective and unfortunately, probably the second will be too. There will be massive power available and I'm sure some cardiologist will use all 760,000 people to get a p<0.00000000001 and a OR of 2.5+/- 0.00004.
But more importantly and maybe revere you could write an article about this someday, pretty please, with many thanks on top...
I would like to see more Attributable risk and AR%. 76,000 COPD patients taking statins, if ever there was a time for someone to put there data where there mouth is, I'd say this is a good one.
"People who use statin drugs are less likely to die of influenza and chronic bronchitis..."
"People on statins also had a lower risk of dying from influenza and pneumonia..."
"...those who take statins for at least 90 days had a much lower risk of dying from chronic obstructive pulmonary disease or COPD, the technical name for emphysema and chronic bronchitis."
Could it be that those who receive excellent medical care, are tested yearly by their doctor and are prescribed and can afford daily treatments with statins...might choose to take daily vitamins or drink pure spring water...or are less likely to have poor diets and poor housing with poor ventilation and mould and rodent infestations etc. etc. etc?
Could it be that people who take statins are less likely to smoke three packs of cigarettes a day and as a result would be unlikely to get emphysema in the first place...and less likely to get either seasonal influenza or pneumonia?
Is there a reasonable physiological biochemical explanation to back up the hypothesis.
In my opinion, most retrospective studies are flawed because they do not control their variable or admit their limitations when announcing findings to the public.
Who funded the study?
Tom,
I haven't read the current study, as revere said, it is still embargoed. But it's pretty straight forward and standard practice to remove 'confounding factors' before declaring any association between cause and effect. Epidemiological links between statin-use and improved outcomes in previous studies have quite clearly separated out such issues as cigarette smoking and healthcare access, etc, and still come out with favorable results. We'll have to wait to read this one.
What I would like to see is a serious study of the relative effectiveness of statins to stem a cytokine storm, compared with a number of 'natural' and much cheaper approaches to the problem: nutients such as zinc, vitamin C, vitamin B12, vitamin A, as well as a number of known anti-inflamtory substances such as reservatol, garlic, curcumin and boswellia, among others. I don't suppose I will see such study, however, before recommendation$ are made.
Yes, Ron. Some of those other things you mentioned don't require a prescription, doctor visit or any other $$$ going to big pharma.
I hope this study is true, but with all the BS put out there lately about this or that helping XYZ or PDQ funded y the company that makes the drug being tested, I tend to be very cynical of all studies.
Revere, what do you think of the claims of an association between statin use and ALS?
P.: Haven't heard about it. Got a link or cite?
Revere -- I'll try to get something more definitive, but for the moment, here's a link from NASA's Duane Graveline (aka "Spacedoc"):
http://www.spacedoc.net/ALS_statins.html