The Use of Statins and Lung Function in Current and Former Smokers

doi:10.1378/chest.07-0298

Chest

Volume 132, Issue 6, December 2007, Pages 1764-1771

https://doi.org/10.1378/chest.07-0298 Get rights and content

Background

Smokers are affected by a variety of inflammatory diseases, including COPD. Statins, 3-hydroxy-3-methyl-glutaryl-coenzyme-A reductase inhibitors, are used for their lipid-lowering characteristics but also appear to have antiinflammatory and immunomodulatory activities. We assessed their ability to preserve lung function in current and former smokers.

Methods

All smokers and ex-smokers seen at the Oklahoma City VA hospital in 2005 with abnormal baseline spirometry findings and two or more pulmonary function tests done 6 months apart were classified into obstructive and restrictive groups based on the initial PFT result. Statin use, annual decline in FEV₁ and FVC, and need for respiratory-related urgent care (emergency department or inpatient) were compared.

Results

Approximately one half, 215 of 418 patients, were receiving a statin. Compared to the control group, statin users had a lower decline in FEV₁ (− 0.005 ± 0.20 L/yr vs 0.085 ± 0.17 L/yr, p < 0.0001) and FVC (− 0.046 ± 0.45 L/yr vs 0.135 ± 0.32 L/yr, p < 0.0001) [mean ± SD]. This difference remained significant irrespective of whether the patient had obstructive (n = 319), or restrictive (n = 99) disease, and regardless of whether the patient continued or stopped smoking. In patients with an obstructive spirometry finding, we found a lower incidence of respiratory-related urgent care in favor of the statin group (0.12 ± 0.29 patient-years vs 0.19 ± 0.32/patient-years; p = 0.02).

Conclusion

In smokers and former smokers, statins are associated with a slower decline in pulmonary function, independent of the underlying lung disease.

Clinical implication

Prospective, randomized trials are needed to study the effect of statins on lung function.

Section snippets

Materials and Methods

After obtaining institutional review board approval to conduct the study, all smokers and former smokers seen at the Oklahoma City Veterans Administration hospital in 2005 who underwent least two pulmonary function tests (PFTs) ≥ 6 months apart had their medical records reviewed. Since this was a retrospective study utilizing existing data, the institutional review board waived the requirement for subject consent. Patients with normal baseline spirometry results, a clinical history of asthma,

Results

A total of 1,800 patients underwent pulmonary function testing at the Oklahoma City VA Hospital in 2005. Of those, 555 patients had underwent two or more PFTs, meeting the American Thoracic Society guidelines for acceptability and reproducibility, done at least 6 months apart. One hundred thirty-seven patients were excluded (never smoked, history of asthma, and/or normal baseline spirometry), leaving 418 patients eligible for analysis (414 men and 4 women). Average age was 66.8 ± 9.3 years. Two

Discussion

Statins are one of the most widely used groups of medications. Their primary effect is to lower LDL, as well as the total cholesterol, while increasing the high-density lipoprotein. It is believed that this hypocholesterolemic activity is responsible for their beneficial clinical profile, namely the decrease mortality from cardiovascular disease¹² and stroke.¹⁰¹¹ However, treatment with statins may provide greater protection than predicted from cholesterol reduction alone.¹² It is possible that

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Citation Excerpt :
In particular, the intervention study was a pilot study with only 11 participants. While we have seen some important effects on neutrophilic airway inflammation and associated gene changes, a larger study cohort is required to determine whether these effects are clinically important, particularly in light of previous studies which have found that the use of simvastatin, lovastatin, atorvastatin and fluvastatin have been associated with reduced decline in lung function in patients with COPD, ex-smokers and current smokers [74,75]. Another limitation of the study is the sequential study design, which does not allow us to determine whether the effects seen between visits 1 and 3 and visit 2 and 3 are from the combined use of rosuvastatin, lycopene and fish oil or whether they are an effect of long term statin use or just an effect of lycopene and fish oil supplementation.
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: The authors have no conflicts of interest to disclose.

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Chest

Original ResearchCOPDThe Use of Statins and Lung Function in Current and Former Smokers

Background

Methods

Results

Conclusion

Clinical implication

Section snippets

Materials and Methods

Results

Discussion

Am J Med

Lancet

Transplant Proc

Atherosclerosis

Am J Cardiol

Life Sci

Chest

J Am Coll Cardiol

Randomised trial of cholesterol lowering in 4444 patients with coronary heart disease: the Scandinavian Simvastatin Survival Study (4S)

Lancet

Prevention of coronary heart disease with pravastatin in men with hypercholesterolemia: West of Scotland Coronary Prevention Group

N Engl J Med

Statins as anti-inflammatory agents

Trends Pharmacol Sci

Statins and the acute-phase response

N Engl J Med

Simvastatin has anti-inflammatory and antiatherosclerotic activities independent of plasma cholesterol lowering

Arterioscler Thromb Vasc Biol

Simvastatin inhibits cigarette smoking induced emphysema and pulmonary hypertension in rat lungs

Am J Respir Crit Care Med

Statin use is associated with improved function and survival of lung allografts

Am J Respir Crit Care Med

Standardization of spirometry, 1994 update

Am J Respir Crit Care Med

Original Research
COPD
The Use of Statins and Lung Function in Current and Former Smokers