The Association of Cardioprotective Medications with Pneumonia-Related Outcomes
et al. (2014) The Association of Cardioprotective Medications with Pneumonia-Related Outcomes. PLoS
ONE 9(1): e85797. doi:10.1371/journal.pone.0085797
The Association of Cardioprotective Medications with Pneumonia-Related Outcomes
Albert Wu 0
Chester Good 0
John R. Downs 0
Michael J. Fine 0
Mary Jo V. Pugh 0
Antonio Anzueto 0
Eric M. Mortensen 0
Yan Gong, College of Pharmacy, University of Florida, United States of America
0 1 Medical Service, South Texas Veterans Health Care System , San Antonio, Texas , United States of America, 2 Department of Medicine, University of Texas Health Science Center at San Antonio , San Antonio, Texas , United States of America, 3 Departments of Epidemiology and Biostatistics, University of Texas Health Science Center at San Antonio , San Antonio, Texas , United States of America, 4 VA Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania, United States of America, 5 Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America, 6 Medical Service, VA North Texas Health Care System , Dallas, Texas , United States of America, 7 Departments of Internal Medicine and Clinical Sciences, University of Texas Southwestern Medical Center , Dallas, Texas , United States of America
Introduction: Little research has examined whether cardiovascular medications, other than statins, are associated with improved outcomes after pneumonia. Our aim was to examine the association between the use of beta-blockers, statins, angiotensin converting enzyme (ACE) inhibitors, and angiotensin II receptor blockers (ARBs) with pneumonia-related outcomes. Materials and Methods: We conducted a retrospective population-based study on male patients $65 years of age hospitalized with pneumonia and who did not have pre-existing cardiac disease. Our primary analyses were multilevel regression models that examined the association between cardiovascular medication classes and either mortality or cardiovascular events. Results: Our cohort included 21,985 patients: 22% died within 90 days of admission, and 22% had a cardiac event within 90 days. The cardiovascular medications studied that were associated with decreased 90-day mortality included: statins (OR 0.70, 95% CI 0.63-0.77), ACE inhibitors (OR 0.82, 95% CI 0.74-0.91), and ARBs (OR 0.58, 95% CI 0.44-0.77). However, none of the medications were significantly associated with decreased cardiovascular events. Discussion: While statins, ACE inhibitors, and ARBs, were associated with decreased mortality, there was no significant association with decreased CV events. These results indicate that this decreased mortality is unlikely due to their potential cardioprotective effects.
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Funding: This work was supported by grant number (R01NR010828) from the National Institute of Nursing Research. This material is the result of work supported
with resources and the use of facilities at the South Texas Veterans Health Care System. The funders had no role in study design, data collection and analysis,
decision to publish, or preparation of the manuscript.
Competing Interests: The authors have declared that no competing interests exist.
Pneumonia affects 4 million people annually and is the eighth
leading cause of death in the United States [1]. In 2007, in the
United States there were 1.1 million hospitalizations due to
pneumonia [2]. The number of patients admitted to hospitals for
pneumonia is increasing, which may be due to an increase in an
aging population as well as an increase in the number of
comorbid conditions [3].
Several studies have indicated that pneumonia may be
associated with increased risk of heart disease, the leading cause
of death in the United States [46]. These studies suggest that
patients with concurrent pneumonia and cardiac events have
significantly higher mortality than patients who only had
pneumonia [4,7]. Recent studies have shown that the use of
statins and/or angiotensin-converting enzyme (ACE) inhibitors
prior to admission is associated with decreased mortality in
patients hospitalized with pneumonia [810]. It is unclear,
however, whether this is due to cardioprotective effects or
noncardiovascular beneficial effects of these medications. In addition,
while research has linked pneumonia and cardiovascular events, it
is unclear whether use of cardioprotective medications, other than
statins, are associated with improved clinical outcomes, such as
mortality or cardiac events, for patients with pneumonia.
The aim of our study was to examine the association between
the use of cardioprotective medications (e.g., beta-blockers, statins,
ACE inhibitors, and ARBs) and 90-day mortality, and hospital
admission due to cardiovascular events within 90-days, for male
patients $65 years of age hospitalized with pneumonia using the
extensive data of the Department of Veterans Affairs
administrative databases. We hypothesized that in patients hospitalized with
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