The risk for coronary artery disease (CAD) was lower in patients with asthma-chronic obstructive pulmonary disease (COPD) overlap syndrome (ACOS) who used statins, regardless of the duration of therapy, whereas the risk for ischemic stroke was lower only in individuals undergoing long-term statin therapy, according to an analysis published in Atherosclerosis.
A retrospective cohort study was conducted using data from the Longitudinal Health Insurance Database, which included 1 million enrollees in the Taiwan National Health Insurance program from January 1, 2000, through December 31, 2011.
Patients ≥20 years of age with ACOS who were treated with statins (n=916) and those who did not receive statin therapy (n=6338) were enrolled in the study. Investigators examined the cumulative incidence of CAD and stroke (both ischemic and hemorrhagic) with the use of time-dependent Cox proportional regression. Following adjustments for age, sex, inhaled corticosteroid use, oral steroid use, and comorbidities, adjusted hazard ratios (aHRs) and 95% CIs for CAD or stroke in statin users (long-term statin use: >600 days; short-term statin use: ≤600 days) were compared with these values in statin nonusers.
In statin users, the aHRs for CAD and stroke were 0.50 (95% CI, 0.41-0.62) and 0.83 (95% CI, 0.63-1.09), respectively. Furthermore, aHRs for ischemic and hemorrhagic stroke were 0.30 (95% CI, 0.09-0.99) and 0.90 (95% CI, 0.68-1.20), respectively. In addition, in long-term statin users, aHRs for CAD and stroke were 0.23 (95% CI, 0.13-0.41) and 0.42 (95% CI, 0.19-0.89), respectively. In short-term statin users, aHRs for CAD and stroke were 0.58 (95% CI, 0.47-0.71) and 0.93 (95% CI, 0.70-1.23), respectively.
A major limitation of the current study is that lipid levels were not taken into account. Moreover, although a new-user study design was employed, with propensity score matching and a time-dependent model for analysis, results were not as accurate as those derived from randomized controlled trials.
The investigators concluded that regardless of the duration of statin use, the risk for CAD was lower in all statin-treated patients with ACOS. In contrast, the risk for ischemic stroke was lower only in long-term statin users with ACOS, and no link was observed between risk for hemorrhagic stroke and use of statin therapy.
Yeh J-J, Lin C-L, Hsu CY, Shae Z, Kao C-H. Associations between statins and coronary artery disease and stroke risks in patients with asthma-chronic obstructive pulmonary disease overlap syndrome: a time-dependent regression study. Atherosclerosis. 2019;283:61-68.