Use of ACE inhibitors and risk of community-acquired pneumonia: a review

Rafailidis, Petros I.; Matthaiou, Dimitrios K.; Varbobitis, Ioannis; Falagas, Matthew E.

doi:10.1007/s00228-008-0467-9

Cited by 24 publications

(15 citation statements)

References 40 publications

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“…This already rules out some important potential sources of heterogeneity. For example, through this we exclude ethnicity [4,25] or genetics [2,26] as a potential explanation for variation in results as has been suggested for the association between ACEi use and pneumonia [27]. In other words, this approach increases the likelihood of detecting methodology and data origin as source of biases leading to the heterogeneity in the case-control study findings [28].…”

Section: Discussionmentioning

confidence: 95%

Sources of heterogeneity in case–control studies on associations between statins, ACE-inhibitors, and proton pump inhibitors and risk of pneumonia

et al. 2014

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The heterogeneity in case-control studies on the associations between community-acquired pneumonia (CAP) and ACE-inhibitors (ACEi), statins, and proton pump inhibitors (PPI) hampers translation to clinical practice. Our objective is to explore sources of this heterogeneity by applying a common protocol in different data settings. We conducted ten case-control studies using data from five different health care databases. Databases varied on type of patients (hospitalised vs. GP), level of case validity, and mode of exposure ascertainment (prescription or dispensing based). Identified CAP patients and controls were matched on age, gender, and calendar year. Conditional logistic regression was used to calculate odds ratios (OR) for the associations between the drugs of interest and CAP. Associations were adjusted by a common set of potential confounders. Data of 38,742 cases and 118,019 controls were studied. Comparable patterns of variation between case-control studies were observed for ACEi, statins and PPI use and pneumonia risk with adjusted ORs varying from 1.04 to 1.49, 0.82 to 1.50 and 1.16 to 2.71, respectively. Overall, higher ORs were found for hospitalised CAP patients matched to population controls versus GP CAP patients matched to population controls. Prevalence of drug exposure was higher in dispensing data versus prescription data. We show that case-control selection and methods of exposure ascertainment induce bias that cannot be adjusted for and to a considerable extent explain the heterogeneity in results obtained in case-control studies on statins, ACEi and PPIs and CAP. The common protocol approach helps to better understand sources of variation in observational studies.

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Section: Discussionmentioning

confidence: 95%

Sources of heterogeneity in case–control studies on associations between statins, ACE-inhibitors, and proton pump inhibitors and risk of pneumonia

et al. 2014

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“…Several studies have shown ACE inhibitors to be somewhat protective against CAP [11,26,[35][36][37] and recurrent pneumonia [11] whereas other studies have failed to find any association [10,38,39]. A critical review performed by Rafailidis et al [40] suggested that ACE inhibitors may contribute to decreased CAP, though most of the studies included in the review showing protective effects comprised of only Asian populations. Other antihypertensive agents have been less studied in CAP; however both beta-blockers and calcium channel blockers have been postulated to increase the risk of pneumonia [41] although the mechanism of risk is unclear.…”

Section: Drug-related Risk Factorsmentioning

confidence: 95%

Recurrent Pneumonia: A Review with Focus on Clinical Epidemiology and Modifiable Risk Factors in Elderly Patients

et al. 2014

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Community-acquired pneumonia (CAP) is one of the most common reasons for physician visits and hospitalizations in North America. Rates of CAP increase with age and CAP is associated with significant morbidity and mortality, especially in the elderly. Though there is much written about the epidemiology and risk factors of incident (first episode) pneumonia, much less is known about recurrent pneumonia. Rates of recurrent pneumonia within 3-5-years of an episode of CAP are 9-12% with a median time to recurrence of 123-317 days and mortality ranging from 4 to 10%. Age ≥65-years-old and impaired functional status are the only patient characteristics that are independently associated with increased risk of recurrence. In terms of modifiable risk factors, only the use of proton-pump inhibitors and systemic and inhaled corticosteroids have consistently been associated with increased risk of recurrent pneumonia, while angiotensin-converting enzyme (ACE) inhibitors may exert a protective effect. Many chronic medical conditions typically associated with increased incident pneumonia-such as chronic obstructive pulmonary disease (COPD), neurological disease (resulting in dysphagia or silent aspiration), and heart failure-were not associated with increased risk of recurrent pneumonia. However, those who are immune-suppressed (e.g., immunoglobulin deficiencies) may be at increased risk of recurrent pneumonia. In summary, among those who survive an episode of pneumonia, recurrence is not uncommon, particularly in the elderly. Following recovery from an episode of pneumonia, patients should be evaluated for risk factors that would predispose to a second episode including seeking evidence of immunosuppression in younger patients and medication optimization, particularly in the elderly.

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“…3,4 Recent studies have investigated whether statins and ACEIs have an impact on pneumonia mortality. 2,[5][6][7][8][9][10][11][12] These studies used hospitalised pneumonia patients as their study population and have provided conflicting evidence. In addition, previous studies have also suggested that proton pump inhibitors (PPIs) and Histamine-2-receptor antagonists (H 2 RAs) are associated with pneumonia morbidity because of their gastric acid suppressant action facilitating bacterial colonisation, [13][14][15][16][17] but have not looked at the impact of these drugs on pneumonia mortality.…”

Section: Introductionmentioning

confidence: 99%

The impact of statins, ace inhibitors and gastric acid suppressants on pneumonia mortality in a UK general practice population cohort

Myles

Hubbard

Gibson

et al. 2009

Pharmacoepidemiology and Drug

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Use of ACE inhibitors and risk of community-acquired pneumonia: a review

Cited by 24 publications

References 40 publications

Sources of heterogeneity in case–control studies on associations between statins, ACE-inhibitors, and proton pump inhibitors and risk of pneumonia

Sources of heterogeneity in case–control studies on associations between statins, ACE-inhibitors, and proton pump inhibitors and risk of pneumonia

Recurrent Pneumonia: A Review with Focus on Clinical Epidemiology and Modifiable Risk Factors in Elderly Patients

The impact of statins, ace inhibitors and gastric acid suppressants on pneumonia mortality in a UK general practice population cohort

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