Statins for COPD?
SOURCE: Zhang W, et al. Chest 2017;152:1159-1168.
Depending on what one reads, COPD is now the third or fourth leading cause of death in the United States. Unfortunately, even though numerous pharmacologic treatments are available to mollify symptoms, none of the currently available treatments can be classified as “disease-modifying.” That is, mortality and disease progression do not appear to be altered by pharmacologic treatment. Why someone thought that statins might be beneficial for patients with COPD escapes me, although certainly it is not surprising that the same commonplace toxin that leads to COPD (smoking) also commonly leads to concomitant cardiovascular consequences in COPD patients.
At any rate, Zhang et al performed a systematic review of clinical trials in COPD patients in which comparison groups of statins vs. placebo were reported (n = 1,471). They found statistically significant benefits for exercise capacity, lung function, and St. George’s Respiratory Questionnaire (a 51-item questionnaire specific to how pulmonary function affects the patient’s life). In contrast, the 2014 STATCOPE trial of simvastatin (n = 884) in COPD patients did not demonstrate improvements in outcomes. Putative benefits from statins in COPD are attributed to the “pleotropic actions” of statins, including decreases in C-reactive proteins and inflammation. Since the population that showed the most benefit in the Zhang et al study were those with pre-existing cardiovascular disease, hyperlipidemia, and elevated C-reactive proteins at baseline, it seems reasonable to ensure that such patients receive appropriate statin treatment so they might enjoy both the expected cardiovascular risk reduction as well as possible pulmonary quality of life improvements.
Even though numerous pharmacologic treatments are available to mollify COPD symptoms, mortality and disease progression do not appear to be altered by pharmacologic treatment.
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