COPD Patients May Derive Significant Benefit From Statin Therapy

Megan Rauscher

July 24, 2009

July 24, 2009 — In patients with chronic obstructive pulmonary disease (COPD), treatment with a statin may have a beneficial effect on several clinically relevant adverse outcomes, including COPD exacerbations and death from COPD or any cause, the results of a systematic review of published studies indicate.

"Data from our review suggest that statins may have the potential to alter prognosis for survival or decline in lung function in COPD patients — a target that is not clearly achieved with any current COPD medication," Dr. Claudia C. Dobler from Liverpool Hospital and the Woolcock Institute of Medical Research, Sydney, New South Wales, Australia told Reuters Health.

COPD is a common disease with a "high burden to society on a worldwide scale," Dr. Dobler and colleagues note in the BMC journal Pulmonary Medicine, published online July 12. Statins have recently been recognized as possible disease-modifying agents in COPD.

To investigate further, Dr. Dobler and colleagues reviewed eight papers reporting nine original studies published between 2006 and 2008 that specifically analyzed the effects of statin treatment on COPD. One was a randomized controlled trial, one was a retrospective nested case-control study, five were retrospective cohort studies, of which one was linked with a case-control study, and one was a retrospective population-based analysis.

Based on the data analyzed, statin therapy for COPD was associated with decreased all-cause mortality in three out of four studies (odds ratio/hazard ratio 0.48-0.67 in three studies, OR 0.99 in one study) and decreased COPD-related mortality (OR 0.19-0.29).

Statin therapy was also associated with a reduced incidence of respiratory-related urgent care (OR 0.74); COPD exacerbations and need for intubation (OR 0.43 and OR 0.1, respectively); and statins also attenuated decline of pulmonary function.

The one randomized controlled trial investigated the effects of pravastatin 40 mg/day versus placebo over 6 months in 125 clinically stable COPD patients. In this trial, it was reported that statin users experienced significant improvements in exercise capacity and dyspnea after exercise in association with decreased levels of the inflammatory markers, C-reactive protein and interleukin-6, but no improvement in lung function.

"While statins seem to influence systemic inflammation and cardiovascular morbidity in COPD patients, it appears likely that they also directly target airway inflammation," the reviewers note.

"Many COPD patients," Dr. Dobler added in comments to Reuters Health, "have an increased cardiovascular risk and therefore already qualify for preventive statin treatment based on current lipid management guidelines. However, in clinical practice the cardiovascular risk is often not systematically assessed in COPD patients. I would encourage every clinician to check whether their COPD patients have an indication for preventive statin treatment based on current guidelines (by assessing smoking status, lipid profile, diabetes risk and blood pressure)."

Dr. Dobler and colleagues note that it is not clear from existing data what types of statins, dosage, and length of treatment are needed to exhibit a pleiotropic effect.

They also point out that because most of the available data are based on observational studies, randomized controlled trials are "urgently needed to evaluate the therapeutic effect of statins in COPD."

"We are currently in the process of recruiting participants for an interventional study looking at the benefits of statin treatment and dietary antioxidants in people with COPD," Dr. Dobler noted.

BMC Pulm Med. 2009;9:32.

Reuters Health Information 2009. © 2009 Reuters Ltd.

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