Statin Use and Risk of COPD Exacerbation Requiring Hospitalization

Wang, Meng Ting; Lo, Yu Wen; Tsai, Chia‐Lin; Chang, Li Chien; Malone, Daniel C.; Chu, Che Li; Liou, Jun-Ting

doi:10.1016/j.amjmed.2013.01.036

Cited by 99 publications

(95 citation statements)

References 36 publications

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“…For example, database studies have shown the use of statins that reduce mortality in cardiovascular disease, also appear to reduce mortality in patients with COPD [5]. Although this could be explained by a reduction in cardiovascular deaths among COPD patients there is also an apparent reduction in acute exacerbations, suggesting an effect on the lung disease [6], and also a reduction is associated lung cancers. This suggests that statins may be targeting pathogenetic pathways.…”

Section: Introductionmentioning

confidence: 99%

Mechanisms of development of multimorbidity in the elderly

2015

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In ageing populations many patients have multiple diseases characterised by acceleration of the normal ageing process. Better understanding of the signalling pathways and cellular events involved in ageing shows that these are characteristic of many chronic degenerative diseases, such as chronic obstructive pulmonary disease (COPD), chronic cardiovascular and metabolic diseases, and neurodegeneration. Common mechanisms have now been identified in these diseases, which show evidence of cellular senescence with telomere shortening, activation of PI3K-AKT-mTOR signalling, impaired autophagy, mitochondrial dysfunction, stem cell exhaustion, epigenetic changes, abnormal microRNA profiles, immunosenescence and low grade chronic inflammation ("inflammaging"). Many of these pathways are driven by chronic oxidative stress. There is also a reduction in anti-ageing molecules, such as sirtuins and Klotho, which further accelerates the ageing process. Understanding these molecular mechanisms has identified several novel therapeutic targets and several drugs have already been developed that may slow the ageing process, as well as lifestyle interventions, such as diet and physical activity. This indicates that in the future new treatment approaches may target the common pathways involved in multimorbidity and this area of research should be given high priority. Thus, COPD should be considered as a component of multimorbidity and common disease pathways, particularly accelerated ageing, should be targeted. @ERSpublications Multimorbidities share many common underlying mechanisms that may be linked to common causes such as oxidative stress

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Section: Introductionmentioning

confidence: 99%

Mechanisms of development of multimorbidity in the elderly

2015

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“…These results are consistent with our study results that less frequent exacerbations are seen in patients receiving statins. In addition to a lower frequency of exacerbations, a lower rate of exacerbation episodes and requirement of intubations have been reported in COPD patients receiving statins [17]. In a retrospective and population-based study, a decrease in the rate of COPD-related mortality was reported [19].…”

Section: Resultsmentioning

confidence: 99%

“…Furthermore, Mancini et al [14] proposed that ACEi and ARB have similar outcomes. Recently, Wang et al [17] showed that statin use was associated with a 30% decreased risk of COPD exacerbation, and this correlated with drug dose but was independent of the duration of therapy. In our study, patients using ACEi and ARB were not included in order to have a homogenous group and focus on the assessment of statins.…”

Section: Resultsmentioning

confidence: 99%

Influence of Statin Therapy on Exacerbation Frequency in Patients with Chronic Obstructive Pulmonary Disease

et al. 2017

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OBJECTIVES:Chronic obstructive pulmonary disease (COPD) is an inflammatory disease, in which chronic and systemic inflammation plays an important role. By decreasing neutrophil infiltration and cytokine production, statins have anti-inflammatory mechanisms. MATERIALS AND METHODS:Fifty-seven patients who had diagnosis of chronic obstructive pulmonary disease according to GOLD guideline were included in the study; 20 of them were statin users. Statin users group were patients being under medication with regular simvastatin, atorvastatin or rosuvastatin 20 mg per day for at least the past 1 year. RESULTS:There was statistically no significant difference between patients with or without statin treatment with respect to; age, femalemale ratio, COPD severity level, medication used for COPD, pulmonary function tests results and smoking habits. COPD exacerbation frequency in patients using statins was significantly less than patients not using statins (p<0.05). Patient number with COPD exacerbation, antibiotic treatment and outpatient clinic administration and outpatient clinic administration frequency was significantly lower in statin using patients (p<0.05).CONCLUSION: COPD patients receiving statins have a lower frequency of COPD exacarbations, hospital administration and antibiotic treatment compared to patients not receiving statins. KEYWORDS: Statin, COPD, exacerbations INTRODUCTIONChronic obstructive pulmonary disease (COPD) is an inflammatory disease of the lungs characterized by progressive airway obstruction [1]. Some studies have proposed a significant association between smoking and pulmonary inflammation [2,3]. However, recent studies have shown an increase in systemic inflammatory markers in non-smokers, suggesting a possible association with systemic inflammation rather than solitary pulmonary inflammation [4]. Deterioration in pulmonary functions may result in decreased functional capacity, frequent hospitalization, increase in hospitalization rates, and early mortality [5]. Currently, COPD is the fourth leading cause of mortality worldwide and is projected to be the third by 2020 [6]. The economic burden of the disease is high due to close follow-up requirements, hospitalization due to exacerbations, and long-term treatments of the disease. However, the only available options that increase survival rate are oxygen treatment and smoking cessation [7,8].Chronic and systemic inflammation plays an important role in the pathogenesis of COPD. Statins are a class of drugs that inhibit cholesterol production in the liver by blocking the mevalonate pathway. Currently, these drugs are used in the prevention of cardiovascular diseases. In addition to their cholesterol-lowering effects, recent studies have shown that they also possess immune modulatory and pleiotropic effects [9,10]. Decrease in neutrophil infiltration and cytokine production, blockage of matrix remodelling, and slowdown in endothelial and epithelial integrity and apoptosis are the antiinflammatory mechanisms of statins in COPD patients [11]. Recen...

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“…There are a growing number of observational studies that consistently show that statin therapy confers a wide number of benefits in patients with COPD. In the most recent of these observational studies (published in July 2013), a national population-based nested case-control study showed statin use in patients with COPD was associated with a 30% reduction in hospitalization for infective exacerbations [88]. This finding remained after careful adjustment for confounding variables showing both a dose-response effect and a withdrawal effect, making confounding bias an unlikely explanation for this finding (see below) [88].…”

Section: Expert Commentarymentioning

confidence: 94%

Update on the potential role of statins in chronic obstructive pulmonary disease and its co-morbidities

Young¹,

Hopkins

2013

Expert Review of Respiratory Medicine

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Chronic obstructive pulmonary disease (COPD) is soon to become the third leading cause of death in developed countries. COPD is increasingly considered a multisystem disease characterized by both pulmonary and systemic inflammation. Over the last 5 years, there have been a growing number of studies showing that the cholesterol-lowering drugs statins (HMG-CoA reductase inhibitors) have a beneficial effect in patients with COPD. While statins are known to have a number of pharmacological effects (pleiotropy) that could explain these benefits, it is currently not clear which effects are most relevant in COPD. This article reviews the most recently published studies of statin therapy in patients with COPD, focusing on the important COPD co-morbidities of the pulmonary system (infective exacerbations, pneumonia, influenza and lung cancer) and cardiovascular system (acute coronary syndrome, endothelial dysfunction and pulmonary hypertension). While we await the results of randomized controlled trials, there continues to be consistent (albeit indirect) evidence from observational studies suggesting statins are beneficial for patients with COPD, conferring important pharmacological effects on inflammation not conferred by current inhaler-based therapies.

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Statin Use and Risk of COPD Exacerbation Requiring Hospitalization

Cited by 99 publications

References 36 publications

Mechanisms of development of multimorbidity in the elderly

Mechanisms of development of multimorbidity in the elderly

Influence of Statin Therapy on Exacerbation Frequency in Patients with Chronic Obstructive Pulmonary Disease

Update on the potential role of statins in chronic obstructive pulmonary disease and its co-morbidities

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