Effectiveness of long-term using statins in COPD – a network meta-analysis

Abstract

ObjectivesTo evaluate the effectiveness of long-term treatment of statins for chronic obstructive pulmonary disease (COPD), and to answer which one is better.MethodsGeneral meta-analysis was performed to produce polled estimates of the effect of mortality, inflammatory factors, and lung function index in COPD patients by the search of PubMed, Web of Science, Embase, and China National Knowledge Infrastructure for eligible studies. A network meta-analysis was performed to synthetically compare the effectiveness of using different statins in COPD patients.ResultsGeneral meta-analysis showed that using statins reduced the risk of all-cause mortality, heart disease-related mortality and COPD acute exacerbation (AECOPD) in COPD patients, the RR (95% CI) were 0.72 (0.63,0.84), 0.72 (0.53,0.98) and 0.84 (0.79,0.89), respectively. And using statins reduced C-reactive protein (CRP) and pulmonary hypertension (PH) in COPD patients, the SMD (95% CI) were − 0.62 (− 0.52,-0.72) and − 0.71 (− 0.85,-0.57), respectively. Network meta-analysis showed that Fluvastatin (97.7%), Atorvastatin (68.0%) and Rosuvastatin (49.3%) had higher cumulative probability than other statins in reducing CRP in COPD patients. Fluvastatin (76.0%) and Atorvastatin (75.4%) had higher cumulative probability than other satins in reducing PH in COPD patients.ConclusionsUsing statins can reduce the risk of mortality, the level of CRP and PH in COPD patients. In addition, Fluvastatin and Atorvastatin are more effective in reducing CRP and PH in COPD patients.Electronic supplementary materialThe online version of this article (10.1186/s12931-019-0984-3) contains supplementary material, which is available to authorized users.

Pulmonary hypertension in chronic obstructive pulmonary disease

“…As in one earlier study the treatment with simvastatin was able to inhibit the development of elastase‐induced pulmonary emphysema in mice (Takahashi et al, 2008), these findings highlight the diversity in the pleiotropic effects within this class of drugs. Differences between statins are also evident from the clinical trials, which are, nevertheless, showing reduced PH and improvement in lung function in COPD–PH patients treated with statins (Lu et al, 2019; Reed et al, 2011; Zhang et al, 2017). It is worth mentioning that even in those patients that benefited from the statin treatment, reduction in PAP was moderate compared with the complete reversal of PH seen in animal models.…”

Hypoxia‐inducible factor and bacterial infections in chronic obstructive pulmonary disease

“…154 Another class of therapeutics include statins, which reduce inflammation in particular C-reactive protein and pulmonary hypertension in COPD. 160 Simvastatin reduced airway PAFR expression and lung bacterial burden in pneumococcal infection in a mouse model of sickle cell disease. 161 Thus, it is possible that statin therapy in COPD may alleviate the risk of bacterial infections by downregulating the PAFR, although this needs to be validated in both experimental models and clinical trials.…”

“…Another class of therapeutics include statins, which reduce inflammation in particular C‐reactive protein and pulmonary hypertension in COPD . Simvastatin reduced airway PAFR expression and lung bacterial burden in pneumococcal infection in a mouse model of sickle cell disease .…”

Non‑cytotoxic doses of shikonin inhibit lipopolysaccharide‑induced TNF‑α expression via activation of the AMP‑activated protein kinase signaling pathway

“…Chronic obstructive pulmonary disease (COPD) occurs in >380 million individuals globally, especially amongst adults aged >30 years (1). The global prevalence of COPD is expected to increase continuously during the next few decades due to an ageing population, uncontrolled smoking prevalence in developing countries and additional environmental exposures such as air pollution and biomass fuel exposure (2).…”