Long-Term Use of Statins Reduces Mortality, Inflammation in COPD, Review Says

A recent review showed that the long-term use of statins reduced the risk of acute exacerbation in chronic obstructive pulmonary disease (COPD), heart disease—related mortality and all-cause mortality, as well as decreased inflammatory factors.

It is already known that comorbidities worsen outcomes in COPD, and the researchers noted that cardiovascular disease (CVD) is prevalent in patients with COPD. Pulmonary hypertension (PH), in particular, is one of the most severe accompanying illnesses.

In addition, the authors said there is a growing understanding of systemic inflammation in a subset of patients with COPD, and they said high levels of C reactive protein (CRP) and IL-6 have been associated with poor outcomes.

The authors conducted a meta-analysis to produce polled estimates of the effect of mortality, inflammatory factors, and lung function index in COPD patients by searching 4 databases (PubMed, Web of Science, Embase, and China National Knowledge Infrastructure) between January 1990 to March 2018.

Researchers also conducted a network meta-analysis to synthetically compare the effectiveness of using different statins in patients with COPD.

Studies were included if they met 6 criteria:

• Published cohort studies or randomized controlled trials
• Studies with ≥1 months of follow-up
• Relative risk (RR), hazard ratio estimated with 95% CI or sufficient data to calculate were reported for binary variables; standardized mean difference estimated with 95% CI or sufficient data to calculate were reported for continuous variables
• Studies in which the number of events and total number of participants in each study group were reported
• The outcomes of interest were long-term outcome indicators, including all-cause and cause-specific mortality, and short-term outcome indicators, including inflammatory factors of CRP, IL (interleukin)-6, IL-8, and tumor necrosis factor-α; lung function index of forced expiratory volume in 1 second percent (FEV₁), FEV₁/forced vital capacity, and PH; and other factors
• Interventions included 2 groups of statin and placebo

Out of 988 studies, the researchers settled on a final number of 53 to use in the analysis. The analysis showed that using statins reduced the risk of all-cause mortality, heart disease-related mortality and acute exacerbation in COPD. The RRs (95% CI) were 0.72 (0.63,0.84), 0.72 (0.53,0.98), and 0.84 (0.79,0.89), respectively.

Using statins reduced CRP and PH in COPD patients. The standardized mean difference (95% CI) were —0.62 (–0.52,–0.72) and –0.71 (–0.85,–0.57), respectively.

Network meta-analysis showed that fluvastatin (97.7%), atorvastatin (68%), and rosuvastatin (49.3%) had higher cumulative probability than other statins in reducing CRP in COPD patients. Fluvastatin (76%) and atorvastatin (75.4%) had higher cumulative probability than other satins in reducing PH in COPD patients.

The researchers said their study answers whether statins can reduce inflammation and PH, and which statin is more effective for COPD.

Reference

Lu Y, Chang R, Yao J, Xu X, Teng Y, Cheng N. Effectiveness of long-term using statins in COPD - a network meta-analysis. [published online January 23, 2019]. Respir Res. doi:10.1186/s12931-019-0984-3.