Statin therapy on pulmonary function in patients with COPD: a meta-analysis of randomized controlled trials

doi:10.5246/jcps.2018.04.029

Abstract

Abstract:

In thecurrent meta-analysis, we aimed to investigate the therapeutic effects of statins on pulmonary function inpatients with chronic obstructive pulmonary disease (COPD).MEDLINE, EMBASE and Cochrane Central Register of clinical trials were systematically searched until January 2017 for RCTs of statins. Only trials with COPD patients were included.The I²statistic was used to measure heterogeneity between trials and calculated mean differences for pulmonary function parameters with fixed-effect meta-analysis.Eighteligible studies with 534 participants were identified. Statin therapy had no remarkable influence on FEV1 (SMD –0.01, 95% CI –0.204 to 0.184, I²=0.0%, P = 0.922, n = 409), FEV1/ FVC (SMD 0.163, 95% CI –0.044to 0.369, I²=0.0%, P = 0.123, n = 364), 6MWD, heart rate or CRP. However, exercise time on treadmill was remarkably improved by statin therapy (SMD 1.271, 95% CI 0.930 to 1.612, I²=0.0%, P = 0.000, n = 160). Subgroup analysis showed significant, ameliorative effect of pravastatin on FEV1/FVC (SMD 0.362, 95% CI 0.049 to 0.674, I²=0.0%, P = 0.023).The results of this meta-analysis showed non-significant effect of statins on pulmonary function in COPD patients. Based on the studies reviewed, it is not recommended to prescribe statins for COPD patients without CVD risk factors due to lack of clearly defined benefit.

Key words: Statins, Pulmonary function, COPD, Meta-analysis

CLC Number:

R974

Supporting:

Yi Zhou, Jun Wang, Long Zhang. Statin therapy on pulmonary function in patients with COPD: a meta-analysis of randomized controlled trials[J]. Journal of Chinese Pharmaceutical Sciences, 2018, 27(4): 281-288.

References

[1] Kuklina, E.V.; Carroll, M.D.; Shaw, K.M.; Hirsch, R. Trends in high LDL cholesterol, cholesterol-lowering medication use, and dietary saturated-fat intake: United States, 1976-2010. NCHS Data Brief. 2013, 117, 1-8.

[2] Desai, C.S.; Martin, S.S.; Blumenthal, R.S. Non-cardiovascular effects associated with statins. BMJ. 2014, 349, g3743.

[3] Murphy, S.L.; Xu, J.; Kochanek, K.D. Deaths: final data for 2010. Natl. Vital. Stat. Rep. 2013, 61, 111-117.

[4] Yeganeh, B.; Wiechec, E.; Ande, S.R.; Sharma, P.; Moghadam, A.R.; Post, M.; Freed, D.H.; Hashemi, M.; Shojaei, S.; Zeki, A.A.; Ghavami, S. Targeting the mevalonate cascade as a new therapeutic approach in heart disease, cancer and pulmonary disease. Pharmacol. Ther. 2014, 143, 87-110.

[5] Wang, M.T.; Lo, Y.W.; Tsai, C.L.; Chang, L.C.; Malone, D.C.; Chu, C.L.; Liou, J.T. Statin use and risk of COPD exacerbation requiring hospitalization. Am. J. Med. 2013, 126, 598-606.

[6] Ingebrigtsen, T.S.; Marott, J.L.; Nordestgaard, B.G.; Lange, P.; Hallas, J.; Vestbo, J. Statin use and exacerbations in individuals with chronic obstructive pulmonary disease. Thorax. 2015, 70, 33-40.

[7] Lee, T.M.; Lin, M.S.; Chang, N.C. Usefulness of C-reactive protein and interleukin-6 as predictors of outcomes in patients with chronic obstructive pulmonary disease receiving pravastatin. Am. J. Cardiol. 2008, 101, 530-535.

[8] Lee, T.M.; Chen, C.C.; Shen, H.N.; Chang, N.C. Effects of pravastatin on functional capacity in patients with chronic obstructive pulmonary disease and pulmonary hypertension. Clin. Sci. 2009, 116, 497-505.

[9] Kaczmarek, P.; Sladek, K.; Skucha, W.; Rzeszutko, M.; Iwaniec, T.; Dziedzina, S.; Szczeklik, A. The influence of simvastatin on selected inflammatory markers in patients with chronic obstructive pulmonary disease. Pol. Arch. Med. Wewn. 2010, 120, 11-17.

[10] Moosavi, S.A.; Raji, H.; Faghankhani, M.; Yazdani, R.; Esmaeili, M. Evaluation of the Effects of Atorvastatin on the Treatment of Secondary Pulmonary Hypertension due to Chronic Obstructive Pulmonary Diseases: A Randomized Controlled Trial. Iran. Red. Crescent. Med. J. 2013, 15, 649-654.

[11] Ghobadi, H.; Lari, S.M.; Pourfarzi, F.; Mahmoudpour, A.; Ghanei, M. The effects of atorvastatin on mustard-gas-exposed patients with chronic obstructive pulmonary disease: A randomized controlled trial. J. Res. Med. Sci. 2014, 19, 99-105.

[12] Neukamm, A.; Hoiseth, A.D.; Einvik, G.; Lehmann, S.; Hagve, T.A.; Søyseth, V.; Omland, T. Rosuvastatin treatment in stable chronic obstructive pulmonary disease (RODEO): a randomized controlled trial. J. Intern. Med. 2015, 278, 59-67.

[13] John, M.E.; Cockcroft, J.R.; McKeever, T.M.; Coward, W.R.; Shale, D.J.; Johnson, S.R.; Thornton, J.G.; Harrison, T.W.; Knox, A.J.; Bolton, C.E. Cardiovascular and inflammatory effects of simvastatin therapy in patients with COPD: a randomized controlled trial. Int. J. Chron. Obstruct. Pulmon. Dis. 2015, 10, 211-221.

[14] Balaguer, C.; Peralta, A.; Ríos, A.; Iglesias, A.; Valera, J.L.; Noguera, A.; Soriano, J.B.; Agustí, A.; Sala-Llinas, E. Effects of simvastatin in chronic obstructive pulmonary disease: Results of a pilot, randomized, placebo-controlled clinical trial. Contemp. Clin. Trials. 2016, 2, 91-96.

[15] Criner, G.J.; Connett, J.E.; Aaron, S.D.; Albert, R.K.; Bailey, W.C.; Casaburi, R.; Cooper, JA. Jr.; Curtis, J.L.; Dransfield, M.T.; Han, M.K.; Make, B.; Marchetti, N.; Martinez, F.J.; Niewoehner, D.E.; Scanlon, P.D.; Sciurba, F.C.; Scharf, S.M.; Sin, D.D.; Voelker, H.; Washko, G.R.; Woodruff, P.G.; Lazarus, S.C.; COPD Clinical Research Network; Canadian Institutes of Health Research. Simvastatin for the prevention of exacerbations in moderate-to-severe COPD. N. Engl. J. Med. 2014, 370, 2201-2210.
[16] Criner, G.J.; Bourbeau, J.; Diekemper, R.L.; Ouellette, D.R.; Goodridge, D.; Hernandez, P.; Curren, K.; Balter, M.S.; Bhutani, M.; Camp, P.G.; Celli, B.R.; Dechman, G.; Dransfield, M.T.; Fiel, S.B.; Foreman, M.G.; Hanania, N.A.; Ireland, B.K.; Marchetti, N.; Marciniuk, D.D.; Mularski, R.A.; Ornelas, J.; Road, J.D.; Stickland, M.K. Prevention of acute exacerbations of COPD: American College of Chest Physicians and Canadian Thoracic Society Guideline. Chest. 2015, 147, 894-942.