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January 2014

January 2014

Statin Use Reduces Delirium in Critically Ill Patients

Continued use of statins may help prevent delirium in critically ill patients who received statins before hospital admission, according to a new study of 470 intensive care patients in the UK.

“This is the first study using a validated delirium screening tool, the Confusion Assessment Method-ICU (CAM-ICU), to show that the administration of statins reduces delirium in these patients,” said lead author Valerie J Page MB ChB, of the Watford General Hospital in Watford, UK. “This benefit may be mediated by a reduction in systemic inflammation.”

The findings were published online ahead of print publication in the American Thoracic Society’s American Journal of Respiratory and Critical Care Medicine.

Of the 470 patients included in the study, 151 received statins. Statins were only administered to patients who had received statins prior to admission.

After adjustment for age, sex and illness severity, administration of statins the previous evening was associated with a significantly lower risk of delirium and a concomitant reduction in serum C-reactive protein (CRP), a marker of systemic inflammation, the following day. The strength of the relationship between statin use and a lower risk of delirium was reduced when CRP was adjusted for.

“Although the pathogenesis of delirium is not fully understood, these data are consistent with a neuro-inflammatory cause and suggest that the anti-inflammatory effects of statins may contribute to the effects of statin treatment on delirium,” said Dr. Page. “Our study on statin use and the risk of delirium in critically ill subjects included extensive data on a large, broadly representative population of consecutive intensive care patients, increasing its strength.”  

Study limitations include the possibility that not all potential confounding factors were adjusted for and the limits of cognitive assessment tools in critically ill patients.

“Our findings suggest that statin treatment should be continued to help prevent delirium in critically ill patients who received statins before being admitted,” said Dr. Page.

 “The relationship between statin therapy and delirium and the mechanisms underlying this relationship are the subject of an ongoing randomized, placebo-controlled study in critically ill ventilated patients.”

American Thoracic Society Welcomes Release of Surgeon General’s 50th Anniversary Report on Smoking and Health

The Health Consequences of Smoking—50 Years of Progress: A Report of the Surgeon General, 2014 is available here: http://www.surgeongeneral.gov/library/reports/50-years-of-progress/full-report.pdf. The report cites more than 100 references from the ATS journals American Journal of Respiratory and Critical Care Medicine and American Journal of Respiratory Cell and Molecular Biology.

January 16, 2014 – On the 50th anniversary of the Surgeon General’s Report on Smoking and Health, the American Thoracic Society and its members reaffirm their long commitment to understanding and fighting against the diseases and mortality caused by smoking.

"At this point, we're still identifying new consequences of active and passive smoking, which is quite remarkable 50 years on," says Jonathan M. Samet, MD, senior scientific editor of the 2014, 2006, and 2004 Surgeon General’s reports and professor and Flora L. Thornton chair in the Department of Preventive Medicine at the Keck School of Medicine at the University of Southern California, and director of the USC Institute for Global Health.

Dr. Samet is a member of the American Thoracic Society’s Tobacco Action Committee, which coordinates the Society’s tobacco control activities, including research, clinical, educational, advocacy and policy activities, with the ultimate goal of minimizing the impact of tobacco on morbidity and mortality worldwide.

"The heterogeneity of the tobacco epidemic is an important consideration," Dr. Samet says. "In 1964, the majority of men and a substantial proportion of women smoked. Now smoking is far higher among disadvantaged people with less education, and less money. What will be important about this anniversary report is a statement as to where the nation is going to go in its efforts to curb tobacco use further."

Dr. Samet notes that the list of cancers known to be caused by smoking will continue to grow, and that the report's authors looked closely at smoking, immunity and diseases such as rheumatoid arthritis. "There are health problems related to smoking that are of importance to clinicians and patients that have not been recognized as well as they should," Dr. Samet says.

Data from the Surgeon General's reports indicates that:

  • More than 440,000 Americans die every year from smoking.
  • Eight million Americans live with at least one serious chronic disease caused by smoking.
  • The cost of smoking to the U.S. economy is $193 billion a year, including nearly $96 billion in direct medical costs and an additional $97 billion in lost productivity.

The new report will have an extensive chapter regarding usage of tobacco products, but the emergence of e-cigarettes and that new industry's nearly $2 billion market could only be acknowledged, as not enough research and conclusive evidence is yet available. "It's a different market from the tobacco market," Dr. Samet says. "All of the major tobacco companies have an e-cigarette product, but there are many additional companies with e-cigarettes."

Science and discoveries by ATS members have always played an important role in the Surgeon General reports and in advocacy efforts. "The ATS has a strong history of supporting tobacco control measures," says ATS President Patricia Finn, MD. "Our tobacco control strategies include efforts to reduce respiratory health disparities as different groups, including minorities, the poor and the mentally ill,  are disproportionately affected."

"The 50th anniversary Report on Smoking and Health reminds us of how far we've come, and how far we have to go," says Frank T. Leone, MD, MS, associate professor of medicine at the University of Pennsylvania and vice-chair of the ATS Tobacco Action Committee. "ATS members are making critical contributions to our understanding of the complex social, environmental, and biological determinants of tobacco dependence, which will in turn help guide future tobacco control strategies."

Dr. Samet adds: "Good science is a critical starting point for tobacco control, and the ATS has been an important venue for the exchange of information. What the ATS can do as an organization is to make certain that the translational significance of the research is understood by decision makers. The ATS is one of the many voices calling for tobacco control, and I think we need as many voices as possible."

 

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