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Statin use and exacerbations in individuals with chronic obstructive pulmonary disease
  1. Truls S Ingebrigtsen1,2,3,
  2. Jacob L Marott2,
  3. Børge G Nordestgaard2,3,4,
  4. Peter Lange2,3,5,6,
  5. Jesper Hallas7,
  6. Jørgen Vestbo8,9
  1. 1Department of Respiratory Medicine, Odense University Hospital, and Institute of Clinical Research, University of Southern Denmark, Odense, Denmark
  2. 2The Copenhagen City Heart Study, Frederiksberg Hospital, Copenhagen, Denmark
  3. 3The Copenhagen General Population Study, Herlev Hospital, Copenhagen University Hospital, University of Copenhagen, Copenhagen, Denmark
  4. 4Department of Clinical Biochemistry, Herlev Hospital, Copenhagen University Hospital, University of Copenhagen, Copenhagen, Denmark
  5. 5Respiratory Section, Hvidovre Hospital, Copenhagen University Hospital, University of Copenhagen, Copenhagen, Denmark
  6. 6Department of Social Medicine, Institute of Public Health, University of Copenhagen, Copenhagen, Denmark
  7. 7Department of Clinical Pharmacology, University of Southern Denmark, Odense, Denmark
  8. 8Department of Respiratory Medicine, Gentofte Hospital, Copenhagen University Hospital, University of Copenhagen, Copenhagen, Denmark
  9. 9Respiratory and Allergy Research Group, Manchester Academic Health Sciences Centre, University Hospital South Manchester NHS Foundation Trust, Manchester, UK
  1. Correspondence to Professor Jørgen Vestbo, Department of Respiratory Medicine, Gentofte Hospital, Niels Andersens Vej, 65, Hellerup 2900, Denmark; Jorgen.Vestbo{at}manchester.ac.uk

Abstract

Background We tested the hypothesis that statin use in individuals with COPD is associated with a reduced risk of exacerbations.

Methods We identified 5794 individuals with COPD and a measurement of C reactive protein (CRP) in the Copenhagen General Population Study (2003–2008). During 3 years of follow-up we recorded exacerbations with hospital admissions or oral corticosteroid treatment. In a nested case-control design, matching on age, gender, smoking, COPD severity and comorbidity, we estimated the association between statin use and exacerbations. In addition, we examined the association between statin use and high CRP (>3 mg/L), and the association between high CRP and exacerbations during follow-up.

Results Statin use was associated with reduced odds of exacerbations in crude analysis, OR=0.68 (95% CI 0.51 to 0.91, p=0.01), as well as in multivariable conditional logistic regression analysis, OR=0.67 (0.48 to 0.92, p=0.01). However, in the subgroup with the most severe COPD and without cardiovascular comorbidity, we observed a null association between statin use and exacerbations, OR=1.1 (0.5 to 2.1, p=0.83). Furthermore, statin use was associated with reduced odds of a high CRP, OR=0.69 (0.56 to 0.85, p<0.001), and a high CRP was associated with an increased risk of exacerbations, HR=1.62 (1.35 to 1.94, p<0.001). We estimated the percentage of excess risk of the association of statin use with exacerbations possibly mediated through a reduction of CRP to be 14% (4–51%).

Conclusions Statin use was associated with reduced odds of exacerbations in individuals with COPD from the general population, although this was not apparent in those with the most severe COPD without cardiovascular comorbidity. Statins may thus only associate with reduced risk of exacerbations in patients with COPD with coexisting cardiovascular disease.

  • COPD epidemiology
  • Systemic disease and lungs
  • COPD Pharmacology

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