Statin prescription in patients with chronic obstructive pulmonary disease and risk of exacerbations: a retrospective cohort study in the Clinical Practice Research Datalink

Abstract

ObjectiveObservational studies have suggested a beneficial effect of taking statins on frequency of chronic obstructive pulmonary disease (COPD) exacerbations. However, clinical trials of statins in people with COPD did not confirm those results. This study aimed to investigate this association using a methodological approach, which reduces the biases associated with some previous observational study designs.DesignRetrospective cohort study comparing new-users of statins with non-users.SettingGeneral practices in England contributing to the Clinical Practice Research Datalink in 2007–2017, with linkage to data on Hospital Episode Statistics inpatient episodes.Participants48 124 people with COPD, aged over 40 years, who had not been prescribed statin in the previous year.ExposureParticipants became new-users of statins at their first prescription for a statin during follow-up. They were then assumed to remain statin users. Statin users were compared with non-users.OutcomesPrimary outcomes were COPD exacerbation, or severe exacerbation requiring hospitalisation. Secondary outcomes were death from any cause (for comparison with other studies) and urinary tract infection (negative-control). Maximum follow-up was 3 years. Adjusted HR were calculated using time-dependent Cox regression. The Andersen-Gill model was used for recurrent exacerbations. Covariates included demographic variables, variables related to COPD severity, cardiovascular comorbidities as time-dependent variables, and other comorbidities at baseline.Results7266 participants became new-users of statins over an average 2.5 years of follow-up. In total, 30 961 people developed an exacerbation, 8110 severe exacerbation, 3650 urinary tract infection and 5355 died. Adjusted HR (95% CI) in statin users compared with non-users were first exacerbation 1.01 (0.96–1.06), severe exacerbation 0.92 (0.84–0.99), number of exacerbations 1.00 (0.97–1.04), urinary tract infection 1.10 (0.98–1.23) and death 0.63 (0.57–0.70).ConclusionsIn this study of health records from a Primary Care database, statin use in people with COPD was not associated with a lower risk of COPD exacerbation.

Statins Associated with Better Long-Term Outcomes in Aged Hospitalized Patients with COPD: A Real-World Experience from Pay-for-Performance Program

“…Previous studies have shown that statin is associated with reduced mortality in patients with COPD [38][39][40][41]. The most recent study using real-world cohort conducted in the UK showed that patients with statins treatment were associated with a lower risk of death from any cause, HR = 0.63; 95% CI 0.57 to 0.70, after adjustment for all covariates, although the study results showed that statin use was not associated with a lower risk of COPD exacerbation [42]. In this cohort, the first statin prescription was simvastatin (84%), followed by atorvastatin for 14% [42].…”

“…The most recent study using real-world cohort conducted in the UK showed that patients with statins treatment were associated with a lower risk of death from any cause, HR = 0.63; 95% CI 0.57 to 0.70, after adjustment for all covariates, although the study results showed that statin use was not associated with a lower risk of COPD exacerbation [42]. In this cohort, the first statin prescription was simvastatin (84%), followed by atorvastatin for 14% [42]. Another recent study conducted in Taiwan, using the Taiwan National health insurance database, also showed a significantly lower risk of all-cause mortality for statin-user (HR = 0.76;95% CI = 0.67-0.87, p < 0.001) [43].…”

The Role of Smoking in the Mechanisms of Development of Chronic Obstructive Pulmonary Disease and Atherosclerosis

“…It should be noted that in other studies, statin use was not associated with the risk of COPD exacerbation [238,239]. It has been shown that simvastatin use had no effect on the frequency of COPD exacerbations [240].…”

High-Density Lipoproteins: A Role in Inflammation in COPD

“…However, to date, there is no unequivocal answer on the effectiveness of statins in COPD patients. The use of statins is characterized by different effects on mortality rates and on exacerbations in COPD [ 97 , 98 , 100 , 101 , 102 , 103 , 104 , 105 ]. However, the prescription of statins has a justified value in many clinical situations, given the frequent combination of COPD with cardiovascular diseases of atherosclerotic genesis.…”