Potential Role for Statins in COPD Treatment Armamentarium
Although patients with COPD and comorbid CVD who had higher CRP levels saw a benefit with statins, patients with lower levels did not.
Statins are used to treat hypercholesterolemia, but some evidence also suggests that they may provide benefit in COPD because of their anti-inflammatory and immunomodulatory effects. However, until recently there has been little robust data to support this contention.
A systemic review and meta-analysis published in Chest evaluated the consequences of using statin therapy compared with placebo in randomized controlled trials in COPD. In addition, subgroup analysis was conducted based on inclusion vs exclusion of patients with comorbid cardiovascular disease (CVD), high vs low baseline C-reactive protein (CRP) levels, elevated vs normal cholesterol level, and severity of COPD.
A total of 1471 patients with COPD from 10 studies were included in the analysis. Patients with CVD were excluded from 4 studies. Statins used included simvastatin, atorvastatin, rosuvastatin, and pravastatin.
Statins improved exercise tolerance, pulmonary function, and health-related quality of life in patients with COPD. Patients with comorbid CVD, increased systemic inflammation, or hyperlipidemia appeared to benefit more from statin therapy than other populations. For example, although the improvement in 6-minute walk distance for statin use vs placebo was 15.5 m for the overall population (95% CI, 1.43-29.65 m; P =.03), for those with CVD, it was 19.1 m (95% CI, 3.8-34.4 m; P =.01). There were also trends toward improvement in forced expiratory volume in 1 second (FEV1)% predicted and FEV1/forced vital capacity (FVC) and lower CRP levels with statin therapy in patients with CVD. However, in studies that excluded patients with existing or potential CVD, no benefits were seen using statin therapy.
Patients with higher mean baseline CRP levels (>3 mg/L) experienced a numeric improvement in FEV1% predicted and significantly better FEV1/FVC (P =.01). In contrast, this benefit was not seen in patients with lower baseline CRP levels. Likewise, improvement in FEV1% predicted and significant improvement in FEV1/FVC (P =.01) was observed in patients with baseline low-density lipoprotein cholesterol (LDL-C) levels >120 mg/dL but not in patients with lower baseline LDL-C levels. However, disease severity, as measured by baseline FEV1% predicted, had no effect on the outcomes of statin therapy.
The researchers suggested that these results identify a COPD subgroup — patients with elevated risk for CVD —who may benefit from statin therapy. Study limitations include the small size of contributing studies, heterogeneity in some of the outcomes reported, and differences in the statins and doses used. Nonetheless, the results support routine CV risk assessment in patients with COPD and suggest the need for a large randomized controlled trial to better evaluate these outcomes.
Zhang W, Zhang Y, Li C-W, Jones P, Wang C, Fan Y. Effect of statins on chronic obstructive pulmonary disease: a meta-analysis of randomized controlled trials [published online August 25, 2017]. Chest. 2017. doi:10.1016/j.chest.2017.08.015