PURPOSE: Smokers are affected by a variety of inflammatory diseases, including COPD. Smoking cessation has been the only therapy shown to slow the progression of the disease. Statins, 3-hydroxy-3-methyl-glutaryl-coenzyme-A reductase inhibitors, used for their lipid lowering characteristics, appear to have anti inflammatory and immuno-modulatory activity. This study assesses their usefulness in the management of lung disease in smokers.
METHODS: All patients seen at the Oklahoma City VA hospital in 2005, who had at least 2 pulmonary function tests (PFT) done 6 months apart, had their medical records reviewed. Asthmatics and patients who never smoked were excluded. Based on their initial PFT, patients were divided into obstructive, restrictive, and normal groups. Statin use, annual decline in FEV1 and FVC, need for respiratory related emergency department (ED) visits and hospitalizations were compared.
RESULTS: 485 patients (480 males, 5 females), with first and last PFT 2.7+/−1.6 years apart, were included in the study. The mean age was 66.1+/−2.1 years. The baseline FEV1 and FVC were 57% and 77% of the predicted, respectively. 238 patients (49%) were on statin, with the vast majority (196 patients) being on Simvastatin. Compared to the control group, the statin group had a lower decline in FEV1 (0.012+/−0.21 vs. 0.088+/−0.19 L/y, p<0.0001) and FVC (−0.023+/−0.44 vs. 0.125+/−0.33 L/y, p<0.0001). This beneficial effect of statin use 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. Using Multiple regression analysis, the change in FEV1 correlated only with the change in FVC, whereas the latter correlated only with the use of statins (p<0.0001). Statin use in patients with obstructive PFT led to a 35% decline in the rate of respiratory related ED visits and hospitalization (p=0.02).
CONCLUSION: In smokers and former smokers, statins appear to slow the decline in pulmonary function, independent of the underlying lung disease.
CLINICAL IMPLICATIONS: Prospective, randomized trials are needed to study the effect of statins on lung function.
DISCLOSURE: Walid Younis, None.