The effects of statins on mortality rates among bacteremic patients.

Sir—Liappis et al. [1] noted decreased mortality rates among bacteremic patients who were receiving statins, but they were not able to define the mechanisms by which this reduction in the mortality rate occurred. It has recently been proposed that endothelial apoptosis could be the pivotal event in the pathogenesis of systemic inflammatory response syndrome, sepsis, acute respiratory distress syndrome, and multiple-organ dysfunction syndrome [2]. Endothelial apoptosis is caused by Staphylococcus aureus, lipopolysaccharides, and numerous other factors commonly associated with bacteremia and sepsis, and it can be prevented by the use of statins [2, 3]. Other forms of treatment have a demonstrated effect on endothelial apoptosis. Activated protein C [4], insulin [5], and increased shear stress [6] are antiapoptotic for endothelial cells in vitro and have been found to significantly improve the outcome for critically ill patients [7–9]. These studies and the study by Liappis et al. [1] support the hypothesis that endothelial apoptosis plays a central role in the pathogenesis of some diseases, and that the prevention of endothelial apoptosis can cause significant improvements in the patient’s outcome [2].