The List of Potential Benefits of Statins Grows

Abstract & Commentary

By Barbara A. Phillips, MD, MSPH, Professor of Medicine, University of Kentucky; Director, Sleep DisordersCenter, Samaritan Hospital, Lexington. Dr. Phillips reports no financial relationship to this field of study.

Synopsis: Use of statins is associated with reduced rate of deterioration of lung function with aging, though the effect is reduced in those who continue to smoke.

Source: Alexeeff SE, et al. Statin use reduces decline in lung function. Am J Respir Crit Care Med. 2007;176:742-747.

This paper is a secondary analysis ("data mining") of the Veteran's Administration (VA) Normative Aging Study. The authors analyzed data for 803 men whose mean age was about 71 years. In order to participate in the study, subjects had to be free of known chronic diseases at baseline. Those enrolled in the study filled out questionnaires and had physical examinations and pulmonary function testing every 3 years. About a fourth of the participants were statin users. For the cohort as a whole, those who used statins and those who did not were not different except for a slightly higher number of pack-years (30.9 vs 28.8) for the statin users. A majority were white, and about 30% were never-smokers.

Those who used statins had a rate of decline of Forced Expired Volume in 1 Second (FEV1) and Forced Vital Capacity (FVC) that was about half that of those who did not use statins. Repeat analysis controlling for smoking status yielded similar findings, except that the benefit in lung function was less dramatic for those who continued to actively smoke. For example, in terms of the net difference in rates of decline between statin nonusers and users, the recent quitters had the greatest difference for FEV1 (19.7 ml/yr) and long-time quitters had the greatest net difference for FVC (24.7 ml/yr). In terms of the fold-difference in rates of decline, the long-time quitter group had the highest difference for both FEV1 and FVC.

Commentary

This is the first study to investigate the effects of statin use on decline of pulmonary function by smoking status. That statins could protect lung function is biologically plausible, since they have anti-inflammatory and antioxidant effects1-3, and both inflammation and oxidative stress are considered central to the pathogenesis of COPD.4 In their discussion, the authors note several important caveats, including that this analysis is not a randomized controlled trial, and that those who adhere to statin use may have healthier behaviors in general. But it is an intriguing finding, since our armamentarium to reduce the rate of pulmonary function decline is quite small, and actually only includes smoking cessation at present.

This paper adds to the growing list of potential benefits of statins (in addition to reduced cardiovascular risk). Other possible benefits include improvement of rheumatoid arthritis,5 prevention of colon cancer,6 reduction in dementia risk,7 and perhaps renal protection.8 All of these associations need confirmation with well-done clinical trials, but the preliminary findings are certainly exciting.

References

1. Prasad K. Cardiovasc Drug Rev. 2006;24:33-50.

2. Johnson BA, et al. Am J Respir Crit Care Med. 2003;167:1271-1278.

3. Kurian KC, et al. The effect of statins in heart failure: beyond its cholesterol-lowering effect. J Card Fail. 2006;12:473-478.

4. Pauwels RA, et al. Am J Respir Crit Care Med. 2001;163:1256-1276.

5. Okamoto H, et al. J. Rheumatol. 2007 May;34(5):964-8. Epub 2007 Apr 15.

6. Poynter JN, et al. N Engl J Med. 2005 May 26;352(21):2184-2192.

7. Kuller LH. Curr Atheroscler Rep. 2007 Aug;9(2):154-61.

8. Agarwal R. Mayo Clin Proc. 2007 Nov;82(11):1381-1394.