Influenza: statins may help, but did aspirin misuse hinder in 1918?

By Gareth Macdonald

- Last updated on GMT

Early-stage CDC research suggests that the anti-inflammatory properties of cholesterol-busting statin drugs can help mitigate the impact of flu infection.

The research, which analysed 2,800 people hospitalised by flu in the 07/08 season, showed that patients taking statins were 50 per cent less likely to die from the infection than those who did not.

The findings, presented at a meeting of the Infectious Diseases Society of America (IDSA), suggest statins could be used to reduce the inflammatory symptoms common to both seasonal and pandemic influenza infections, which is particularly timely given concerns about H1N1.

The results are also likely to attract the attention of a pharmaceutical industry keen to extend the revenue generating lifespan of top selling drugs through new patentable disease indications.

The research group, led by Meredith Vandemeer of Oregon’s Public Health Division, is not the first to suggest statins’ anti-inflammatory and Immuno-modulatory effects could be beneficial in the treatment of influenza infection.

A 2006 paper published in the journal of Clinical Infectious Diseases (CID), “Pandemic Influenza: A potential role for statins in treatment and prophylaxis​,” put forward the hypothesis, citing statins’ protective effects in bacteriamia, sepsis and pneumonia as the basis for the idea.

Vandemeer and her team are now assessing whether there is any difference in the level of benefit provided by each type of statin.

Aspirin misuse link to 1918 pandemic deaths

Another CID article, published last month, hypothesises that the high doses of aspirin prescribed to treat patients during the 1918 influenza pandemic may have actually increased the number of deaths.

Author Karen Starko argues that: “The high case fatality rate especially among young adults…is incompletely understood. Although late deaths showed bacterial pneumonia, early deaths exhibited extremely 'wet,' sometimes hemorrhagic lungs.

She goes on to suggest that high dose aspirin may have contributed, explaining that physicians of the day were not aware that aspirin regimens in the 8g to 31g per day range are associated with hyperventilation and pulmonary edema in 33 per cent and 3 per cent of recipients.

Recently, pulmonary edema was found at autopsy in 46 per cent of 26 salicylate intoxicated adults. Experimentally, salicylates increase lung fluid and protein levels and impair mucociliary clearance.

Starko cites the US Surgeon General’s recommendation of aspirin use just before a spike in the number of deaths in 1918, and adds that if this advice was followed “and if pulmonary edema occurred in 3 per cent of persons, a significant proportion of the deaths may be attributable to aspirin​.”

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