Hypolipidemia and Sepsis: It is The Hypolipidemia Not The Statins

To The Editor: I read with great interest the correspondence written by Mathew and Daniel [1], who have the same concerns regarding the potential risks of hypolipidemia [2]. However, Mathew and Daniel referred to the recently published systemic review by Falagas and his colleagues [3], who analyzed twenty studies that examined the use of statins in patients with septicemia and other different bacterial and viral infections. They concluded that statins may have a positive role in treatment of patients with sepsis and infection.

At first glance one might assume that if the risk of mortality is lower in statin users this means that the risk is lower in patients with lower cholesterol as the use of statin will result in lower serum cholesterol levels. However, this is not the case: Falagas and his colleagues did not conclude that the mortality rate was less in the hypolipidemic group but rather it was lower in the statin users which might have a higher cholesterol level, and this is supported by the findings of Yaniv Almog and others [4] who concluded that prior therapy with statins may be associated with a reduced rate of severe sepsis and intensive care admission. But the same investigators in the same study found that the lipid profiles of patients on statin were significantly higher (184.7±51mg/dl) than those of the no-statin group (147.7±43mg/dl). In other words, this study showed that severe sepsis was more common in patients with low cholesterol (they were not on statins). Whether it is statins which were protective in statin users or hypolipidemia which was a risk factor in non statin user, is not clear. In conclusion the various anti-inflammatory effects, not the hypolipidemic effect, of statins seem to explain the protective effect of statins against sepsis, therefore hypolipidemia may still be considered as a risk factor for sepsis.