Statins Significantly Reduce Risk of Hospitalized Exacerbations in Patients With COPD

Statin use was linked with a significant reduction in the risk of hospitalized exacerbations after an initial hospitalized exacerbation among patients with chronic obstructive pulmonary disease (COPD), including specified frequent exacerbators, according to study findings published in the International Journal of Chronic Obstructive Pulmonary Disease.

In patients with COPD, comorbidities such as cardiovascular disease (CVD) and hypertension are common and may contribute to exacerbations. These exacerbations are often caused by systemic inflammation associated with high levels of C reactive protein. Statins have demonstrated anti-inflammatory effects in previous studies, with long-term use shown in a review to reduce mortality and inflammation in COPD. However, the adverse effects associated with statins have caused a debate in its primary use for preventing CVD, contributing to nonadherence among patients.

The potential benefits of statins for the prevention of exacerbations in patients with COPD was noted by the study authors as controversial due to no previous studies having investigated the impact of statins on clinical outcomes in patients with COPD. They sought to delineate this association by examining the risk of subsequent hospitalized exacerbations in patients with COPD in a real-world setting, with an added subgroup analysis of those with frequent exacerbations.

They conducted a population-based cohort study involving patients with COPD with a first hospitalized exacerbation between 2004 and 2012 (n = 139,223), derived from the Taiwan National Health Insurance Research Database. Among the study cohort, those who had a second hospitalized exacerbation within a year after the first exacerbation were defined as frequent exacerbators (n = 35,482).

A ratio of 1 (statin users) to 4 (statin nonusers) was used in the propensity score matching to create matched samples of statin users and nonusers, which was then used in a competing risk regression analysis model to evaluate the association between statin use and exacerbation risk.

In the study findings, statin users with COPD exhibited a significantly reduced risk in subsequent hospitalized exacerbations after their first hospitalized exacerbation compared with nonusers (adjusted subdistribution HR, 0.89; 95% CI, 0.85-0.93, P <.001). Among frequent exacerbators, this significantly reduced risk was also found in the SHR of statin users (0.88; 95% CI, 0.81-0.94, P = .001).

The study authors note that in the subgroup analysis of frequent exacerbators with COPD, the use of statins only provided a protective effect against subsequent hospitalized exacerbations in male patients ≥ 75 years, with coexisting diabetes, hypertension, or CVD.

This finding stresses the influence that comorbidities may have on exacerbation risk. “The beneficial effect of statin use on exacerbations may be partly explained by a reduction in systemic inflammation, and the findings of the current study indicate that cardiovascular disease and hypertension seemed to play a more important role in systemic inflammation and pulmonary inflammation in frequent exacerbators of COPD compared with patients with a first exacerbation,” said the study authors.

Reference

Lin C-M, Yang T-M, Yang Y-H, et al. Statin use and the risk of subsequent hospitalized exacerbations in COPD patients with frequent exacerbations [published online February 10, 2020]. Int J Chron Obstruct Pulmon Dis. doi: 10.2147/COPD.S229047.