1. Introduction
Despite improved management by antibiotic therapy the risk of
hospitalization, morbidity and mortality is still elevated in
community-acquired pneumonia (CAP) patients.1Cardiovascular disease represents a harmful complication occurring in
the early phase of hospitalization.2,3 In a large
prospective study including 1,182 CAP patients, cardiovascular events
such as myocardial infarction (MI), heart failure and stroke occurred in
32% of patients during the first 48 hours from admission and increased
the risk of mortality and cardiovascular recurrences in short- and
long-term follow-up.4
In accordance with this finding, we have previously reported that CAP
patients display an early increase of cardiac troponin, in
>50% of patients, which was accompanied to ECG
modification compatible with NSTEMI in the majority of
cases.5
The impact of corticosteroid use in CAP patients provided conflicting
results with meta-analyses showing a positive effects in terms of
reduction of death,6,7 an effect, however, not
confirmed by others. 8,9 Accordingly, guidelines form
American Thoracic Society and the Infectious Diseases Society of America
advise against the use of corticosteroids in CAP unless of precise
indications for their use as in case of coexistent asthma, chronic
obstructive pulmonary disease (COPD) or autoimmune
diseases.10
Corticosteroids seem to have also an effect on cardiac complications of
CAP patients as shown by a retrospective study conducted in 493 CAP
patients, in which we found that corticosteroid users presented a
significant reduction of MI compared to the
non-users.11 However, this beneficial effect was
limited to patients with concomitant COPD.
Due to the negative association between myocardial injury and long-term
adverse outcomes, we speculated that corticosteroids may prevent
troponin release and eventually reduce major adverse cardiovascular
events (MACE).