Chest
Volume 136, Issue 3, September 2009, Pages 734-743
Journal home page for Chest

Original Research
COPD
Statins in COPD: A Systematic Review

https://doi.org/10.1378/chest.09-0194Get rights and content

Background

The 3-hydroxy 3-methylglutaryl coenzyme A reductase inhibitors (ie, statins) are widely used for the treatment of patients with hypercholesterolemia and cardiovascular disease. Emerging evidence suggests a beneficial effect of statins on the morbidity and mortality of patients with COPD. The objective of this study was to perform a systematic review of the literature evaluating the effect of statin therapy on outcomes in patients with COPD.

Methods

Medline, Excerpta Medica Database, PapersFirst, and the Cochrane collaboration and Cochrane Register of controlled trials were searched. Randomized controlled trials (RCTs), observational cohort studies, case-control studies, and population-based analyses were considered for inclusion.

Results

Nine studies were identified for review (four retrospective cohorts, one nested case-control study of a retrospective cohort, one retrospective cohort and case series, two population-based analyses, and one RCT). All studies showed a benefit from statin therapy for various outcomes in COPD patients, including the number of COPD exacerbations (n = 3), the number of and time to COPD-related intubations (n = 1), pulmonary function (eg, FEV1 and FVC) [n = 1], exercise capacity (n = 1), mortality from COPD (n = 2), and all-cause mortality (n = 3). No studies describing a negative or neutral effect from statin therapy on outcomes in COPD patients were identified.

Conclusions

The current literature collectively suggests that statins may have a beneficial role in the treatment of COPD. However, the majority of published studies have inherent methodological limitations of retrospective studies and population-based analyses. There is a need for prospective interventional trials designed specifically to assess the impact of statins on clinically relevant outcomes in COPD.

Section snippets

Materials and Methods

We decided a priori to examine the published evidence of statin therapy in patients with COPD. Searches were conducted on Medline (inception to December 2008), Excerpta Medica Database (inception to December 2008), PapersFirst (inception to December 2008), and the Cochrane collaboration and Cochrane Register of controlled trials for relevant trials. The following key terms were used: “statins”; “fluvastatin”; “simvastatin”; “atorvastatin”; “rosuvastatin”; “lovastatin”; “pravastatin”;

Results

We identified nine studies15, 16, 17, 18, 19, 20, 21, 22, 23 that described the use of statins and their potential clinical effects in patients with COPD (Fig 1). Of these evaluable studies, four were retrospective cohort studies, one was a nested case-control study of a retrospective cohort, one was a combination retrospective cohort study, two were case-control studies, one was a randomized controlled trial (RCT), and two were population-based analyses (Table 1). The end points that were

Discussion

Statins not only have a proven role in treating CV patients, primarily through their cholesterol-lowering ability, but also possess antiinflammatory and immunomodulatory pleiotropic effects postulated to be beneficial to patients with COPD. We identified nine studies that evaluated the effect of statins on various outcomes in COPD. Eight of the studies were retrospective cohorts, case-control studies, or epidemiologic analyses. Only one interventional study specifically designed to address the

Acknowledgments

Author contributions: Dr. Janda had full access to all the data in the study and takes full responsibility for the integrity of the data and the accuracy of the data analysis. Study concept and design: Drs. Janda and Swiston. Literature search: Drs. Janda and Park. Acquisition of data: Dr. Janda. Analysis and interpretation of data: Drs. Janda, Etminan, and Swiston. Drafting of the manuscript: Drs. Janda and Swiston. Comments and final review: Drs. Fitzgerald and Swiston.

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Funding/Support: Dr. FitzGerald is a Michael Smith Foundation for Health Research Distinguished Scholar and a Canadian Institutes of Health Research/British Columbia Lung Scientist recipient, funded in part by the National Sanitarium Association. Dr. Swiston is a recipient of an In it for Life Scientist award from the Vancouver Coastal Health Research Institute and the Vancouver General Hospital Foundation. Work was performed at the University of British Columbia.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (www.chestjournal.org/site/misc/reprints.xhtml).

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