Я давно это подозревал...
Результаты нового мета-анализа позволили предположить, что плейотропные эффекты статинов полезны в лечении и предотвращении различных инфекций, включая бактериемию, пневмонию, и сепсис.
«Наша объединенная приспособленная оценка, полученная в наблюдательных исследованиях, позволяет предположить, что пациенты с инфекциями, принимающие статины, имеют лучший исход, включая шансы на выживание», - пишут доктор Имад Тлеех (Imad Tleyjeh) (King Fahd Medical City, Riyadh, Saudi Arabia) и коллеги в октябрьскм выпуске «Archives of Internal Medicine». «Кроме того, объединенная приспособленная оценка, полученная в превентивных исследованиях и исследованиях лечения, предполагает, что использование статинов ассоциируется с более низким риском инфекций, несмотря на потенциальные качественные дефициты и предвзятость публикаций».
Предыдущие исследования предположили, что статины уменьшают риск инфекции и связанных с ней осложнений. Авторы выполнили мета-анализ рандомизированных и когортных исследований, рассмотревших ассоциацию между использованием статинов и риском инфекции.
В девяти исследованиях, которые оценивали лечение инфекций со статинами, объединенный приспособленный эффект одобрил использование препаратов, включая влияние на такие конечные точки, как 30-дневная смертность и 30-дневная смертность вследствие инфекции. Точно так же в семи превентивных исследованиях, с наличием хронических заболеваний почек, заболевания сосудов, и нахождением в отделениях интенсивной терапии, лечение статинами уменьшало риск развития инфекции.
Точный механизм, лежащий в основе наблюдаемой ассоциации неизвестен, но эффект может быть приписан иммуномодулирующему и противовоспалительному действию препаратов, сообщают авторы. Однако, необходимы рандомизированные контролируемые исследования, прежде чем статины будут рекомендованы при инфекции. Статины должны быть изучены у пациентов с сепсисом, потому что при приеме препаратов могут иметь место дисфункция печени и миозиты, и эти побочные эффекты опасны при тяжелом септическом состоянии, сопровождающемся печеночной дисфункцией.
По материалам сайта www.solvey-pharma.ru
Statins for the Prevention and Treatment of Infections
A Systematic Review and Meta-analysis
Imad M. Tleyjeh, MD, MSc; Tarek Kashour, MD; Fayaz A. Hakim, MD; Valerie A. Zimmerman, PhD; Patricia J. Erwin, MLS;Alex J. Sutton, PhD; Talal Ibrahim, MBBS(Hons), MD, FRCS(Tr&Orth)
Arch Intern Med. 2009;169(18):1658-1667.
Background Emerging epidemiological evidence suggests that statin use may reduce the risk of infections and infection-related complications. Our objective was to examine the association between statin use and the risk of infections and related outcomes.
Methods We searched several electronic databases from inception through December 2007 for randomized trials and cohort studies that examined the association between statin use and the risk or outcome of infections. Data on study characteristics, measurement of statin use, outcomes (adjusted for potential confounders), and quality assessment were extracted.
Results Sixteen cohorts were eligible and differed in representativeness, outcome assessment, and comparability ofexposed (statin) and unexposed (nonstatin) groups. Nine cohorts addressed the role of statins in treating infections: bacteremia (n = 3), pneumonia (n = 3), sepsis (n = 2), and bacterial infection (n = 1). The pooled adjusted effect estimate was 0.55 (95% confidence interval, 0.36-0.83; I2 = 76.5%) in favor of statins. Seven cohorts addressedinfection prevention in patients with vascular diseases (n = 3), chronic kidney disease (n = 1), diabetes (n = 1),intensive care unit–acquired infections (n = 1), and in general practice (n = 1). The pooled effect estimate was 0.57 (95% confidence interval, 0.43-0.75; I2 = 82%) in favor of statin use; there was some evidence of publication bias for this analysis (Egger test; P = .07). Meta-regression did not identify potential effect modifiers that explain the between-study heterogeneity.
Conclusions Results for our meta-analysis suggest that statin use may be associated with a beneficial effect in treating and preventing different infections. Given the presence of heterogeneity and publication bias, there is a need for randomized trials to confirm the benefit of statin use in this context.
Author Affiliations: Division of Infectious Diseases, Department of Medicine (Dr Tleyjeh), Research Center (Drs Tleyjeh and Zimmerman), and Cardiac Center (Dr Kashour), King Fahd Medical City, Riyadh, Saudi Arabia; Department of Medicine (Drs Tleyjeh and Hakim), Mayo Medical Library (Ms Erwin), Mayo Clinic, Rochester, Minnesota; Section of Cardiology, Department of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada (Dr Kashour); and Division of Orthopedic Surgery (Dr Ibrahim), Department of Health Sciences (Dr Sutton), University of Leicester, Leicester, England
Statins for the Prevention and Treatment of Infections
A Systematic Review and Meta-analysis
Imad M. Tleyjeh, MD, MSc; Tarek Kashour, MD; Fayaz A. Hakim, MD; Valerie A. Zimmerman, PhD; Patricia J. Erwin, MLS;Alex J. Sutton, PhD; Talal Ibrahim, MBBS(Hons), MD, FRCS(Tr&Orth)
Arch Intern Med. 2009;169(18):1658-1667.
Background Emerging epidemiological evidence suggests that statin use may reduce the risk of infections and infection-related complications. Our objective was to examine the association between statin use and the risk of infections and related outcomes.
Methods We searched several electronic databases from inception through December 2007 for randomized trials and cohort studies that examined the association between statin use and the risk or outcome of infections. Data on study characteristics, measurement of statin use, outcomes (adjusted for potential confounders), and quality assessment were extracted.
Results Sixteen cohorts were eligible and differed in representativeness, outcome assessment, and comparability ofexposed (statin) and unexposed (nonstatin) groups. Nine cohorts addressed the role of statins in treating infections: bacteremia (n = 3), pneumonia (n = 3), sepsis (n = 2), and bacterial infection (n = 1). The pooled adjusted effect estimate was 0.55 (95% confidence interval, 0.36-0.83; I2 = 76.5%) in favor of statins. Seven cohorts addressedinfection prevention in patients with vascular diseases (n = 3), chronic kidney disease (n = 1), diabetes (n = 1),intensive care unit–acquired infections (n = 1), and in general practice (n = 1). The pooled effect estimate was 0.57 (95% confidence interval, 0.43-0.75; I2 = 82%) in favor of statin use; there was some evidence of publication bias for this analysis (Egger test; P = .07). Meta-regression did not identify potential effect modifiers that explain the between-study heterogeneity.
Conclusions Results for our meta-analysis suggest that statin use may be associated with a beneficial effect in treating and preventing different infections. Given the presence of heterogeneity and publication bias, there is a need for randomized trials to confirm the benefit of statin use in this context.
Author Affiliations: Division of Infectious Diseases, Department of Medicine (Dr Tleyjeh), Research Center (Drs Tleyjeh and Zimmerman), and Cardiac Center (Dr Kashour), King Fahd Medical City, Riyadh, Saudi Arabia; Department of Medicine (Drs Tleyjeh and Hakim), Mayo Medical Library (Ms Erwin), Mayo Clinic, Rochester, Minnesota; Section of Cardiology, Department of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada (Dr Kashour); and Division of Orthopedic Surgery (Dr Ibrahim), Department of Health Sciences (Dr Sutton), University of Leicester, Leicester, England
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