Chest
Volume 132, Issue 6, December 2007, Pages 1764-1771
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Original Research
COPD
The Use of Statins and Lung Function in Current and Former Smokers

https://doi.org/10.1378/chest.07-0298Get rights and content

Background

Smokers are affected by a variety of inflammatory diseases, including COPD. Statins, 3-hydroxy-3-methyl-glutaryl-coenzyme-A reductase inhibitors, are used for their lipid-lowering characteristics but also appear to have antiinflammatory and immunomodulatory activities. We assessed their ability to preserve lung function in current and former smokers.

Methods

All smokers and ex-smokers seen at the Oklahoma City VA hospital in 2005 with abnormal baseline spirometry findings and two or more pulmonary function tests done 6 months apart were classified into obstructive and restrictive groups based on the initial PFT result. Statin use, annual decline in FEV1 and FVC, and need for respiratory-related urgent care (emergency department or inpatient) were compared.

Results

Approximately one half, 215 of 418 patients, were receiving a statin. Compared to the control group, statin users had a lower decline in FEV1 (− 0.005 ± 0.20 L/yr vs 0.085 ± 0.17 L/yr, p < 0.0001) and FVC (− 0.046 ± 0.45 L/yr vs 0.135 ± 0.32 L/yr, p < 0.0001) [mean ± SD]. This difference remained significant irrespective of whether the patient had obstructive (n = 319), or restrictive (n = 99) disease, and regardless of whether the patient continued or stopped smoking. In patients with an obstructive spirometry finding, we found a lower incidence of respiratory-related urgent care in favor of the statin group (0.12 ± 0.29 patient-years vs 0.19 ± 0.32/patient-years; p = 0.02).

Conclusion

In smokers and former smokers, statins are associated with a slower decline in pulmonary function, independent of the underlying lung disease.

Clinical implication

Prospective, randomized trials are needed to study the effect of statins on lung function.

Section snippets

Materials and Methods

After obtaining institutional review board approval to conduct the study, all smokers and former smokers seen at the Oklahoma City Veterans Administration hospital in 2005 who underwent least two pulmonary function tests (PFTs) ≥ 6 months apart had their medical records reviewed. Since this was a retrospective study utilizing existing data, the institutional review board waived the requirement for subject consent. Patients with normal baseline spirometry results, a clinical history of asthma,

Results

A total of 1,800 patients underwent pulmonary function testing at the Oklahoma City VA Hospital in 2005. Of those, 555 patients had underwent two or more PFTs, meeting the American Thoracic Society guidelines for acceptability and reproducibility, done at least 6 months apart. One hundred thirty-seven patients were excluded (never smoked, history of asthma, and/or normal baseline spirometry), leaving 418 patients eligible for analysis (414 men and 4 women). Average age was 66.8 ± 9.3 years. Two

Discussion

Statins are one of the most widely used groups of medications. Their primary effect is to lower LDL, as well as the total cholesterol, while increasing the high-density lipoprotein. It is believed that this hypocholesterolemic activity is responsible for their beneficial clinical profile, namely the decrease mortality from cardiovascular disease12 and stroke.1011 However, treatment with statins may provide greater protection than predicted from cholesterol reduction alone.12 It is possible that

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    The authors have no conflicts of interest to disclose.

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