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Correspondence |

Statins, Vitamin D, and COPD FREE TO VIEW

Luca Mascitelli, MD; Francesca Pezzetta, MD; Mark R. Goldstein, MD
Author and Funding Information

Correspondence to: Luca Mascitelli, MD, Medical Service, Comando Brigata alpina “Julia,” 8 Via S. Agostino, Udine 33100, Italy; e-mail: lumasci@libero.it


Financial/nonfinancial disclosures: The authors have reported to CHEST that no potential conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (www.chestpubs.org/site/misc/reprints.xhtml).


© 2010 American College of Chest Physicians


Chest. 2010;137(3):742-743. doi:10.1378/chest.09-2219
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To the Editor:

Janda and colleagues1 in their review recently published in CHEST (September 2009) highlighted that statin drugs can have a beneficial role in patients with COPD through their pleiotropic antiinflammatory and immune modulatory effects. We suggest that the same immunomodulatory action might be reached in a safer and cheaper way by adequate vitamin D levels.

Vitamin D status is usually divided into three categories, based on serum 25-hydroxyvitamin D [25(OH)D] levels: “deficient” (≤ 20 ng/mL), “insufficient” (20.1-29.9 ng/mL), and “sufficient” (≥ 30 ng/mL). Serum 25(OH)D levels have been decreasing significantly for more than a decade, resulting in a majority of the US population being vitamin D-insufficient. Indeed, according to the current definition, it is estimated that more than 1 billion people worldwide have impaired serum levels of vitamin D.2 Patients with COPD should be considered at high risk of vitamin D insufficiency because of reduction of outdoor activity, increased glucocorticoids-induced catabolism, impaired activation as a consequence of renal dysfunction, and a lower storage capacity in muscle and fat due to wasting.2 Indeed, it has recently been found that patients with COPD, without chronic use of systemic glucocorticoids, have increased risk for osteoporosis and low levels of vitamin D, which is correlated with the severity of disease.3 Furthermore, the peak in winter and early spring, when 25(OH)D levels are lowest, of exacerbations of autoimmune diseases as well as exacerbations of COPD are in line with the hypothesis that vitamin D, COPD, and adaptive immunity are linked.2

On the other hand, in clinical practice, muscle complaints are a frequent side effect of statin therapy: statins may exacerbate muscle performance and increase falling risk in elderly subjects.4 In fact, an important systemic consequence of COPD is muscle weakness, and this is associated with an increased risk of mortality. Vitamin D plays a role in influencing skeletal muscle function, with deficiency resulting in muscle weakness reversed with vitamin D supplementation. Furthermore, vitamin D supplementation has also been shown to reduce the risk of falls among elderly individuals, and it has been suggested that vitamin D deficiency might explain much of the observed muscle performance decline and increase in falls among elderly statin-treated patients.5 Therefore, because of the cost and side effects of statins drugs, their questionable benefit in the elderly (particularly in the primary prevention of cardiovascular disease), and the increased risk of osteopenia and osteoporosis in COPD, patients with COPD should have adequate levels of vitamin D before considering statin therapy.

Janda S, Park K, FitzGerald JM, Etminan M, Swiston J. Statins in COPD: a systematic review. Chest. 2009;1363:734-743. [CrossRef] [PubMed]
 
Janssens W, Lehouck A, Carremans C, Bouillon R, Mathieu C, Decramer M. Vitamin D beyond bones in chronic obstructive pulmonary disease: time to act. Am J Respir Crit Care Med. 2009;1798:630-636. [CrossRef] [PubMed]
 
Franco CB, Paz-Filho G, Gomes PE, et al. Chronic obstructive pulmonary disease is associated with osteoporosis and low levels of vitamin D. Osteoporos Int. 2009; Mar20  Epub ahead of print.
 
Scott D, Blizzard L, Fell J, Jones G. Statin therapy, muscle function and falls risk in community-dwelling older adults. QJM. 2009;1029:625-633. [CrossRef] [PubMed]
 
Goldstein MR, Mascitelli L, Pezzetta F. Statin therapy, muscle function and vitamin D. QJM. 2009; Sep7  Epub ahead of print.
 

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References

Janda S, Park K, FitzGerald JM, Etminan M, Swiston J. Statins in COPD: a systematic review. Chest. 2009;1363:734-743. [CrossRef] [PubMed]
 
Janssens W, Lehouck A, Carremans C, Bouillon R, Mathieu C, Decramer M. Vitamin D beyond bones in chronic obstructive pulmonary disease: time to act. Am J Respir Crit Care Med. 2009;1798:630-636. [CrossRef] [PubMed]
 
Franco CB, Paz-Filho G, Gomes PE, et al. Chronic obstructive pulmonary disease is associated with osteoporosis and low levels of vitamin D. Osteoporos Int. 2009; Mar20  Epub ahead of print.
 
Scott D, Blizzard L, Fell J, Jones G. Statin therapy, muscle function and falls risk in community-dwelling older adults. QJM. 2009;1029:625-633. [CrossRef] [PubMed]
 
Goldstein MR, Mascitelli L, Pezzetta F. Statin therapy, muscle function and vitamin D. QJM. 2009; Sep7  Epub ahead of print.
 
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