Statin use in COPD patients is associated with a reduction in mortality: a national cohort study

Statins, systemic inflammation and risk of death in COPD: the Rotterdam study

BACKGROUND

Studies suggest that statins decrease mortality in COPD patients but it is unknown which patients might benefit most.

OBJECTIVES

We investigated whether statins were associated with reduced mortality in COPD patients and whether effects differed according to baseline high-sensitivity C-reactive protein (hsCRP) concentration, a marker of systemic inflammation.

METHODS

This nested case-control study was part of the Rotterdam Study, a prospective population-based cohort study among 7983 subjects ≥ 55 years. Using automated pharmacy records, we evaluated statin use of 363 cases (COPD patients who died during follow-up of 17 years) with 2345 age and sex matched controls (COPD patients who survived the follow-up period of the index case).

RESULTS

Compared to never use, long-term statin use (>2 years) was associated with a 39% decreased risk of death in COPD patients. Stratified according to the level of systemic inflammation, long-term statin use was associated with a 78% reduced mortality if hsCRP level > 3 mg/L, versus a non significant 21% reduced mortality if hsCRP level ≤ 3 mg/L.

CONCLUSIONS

Statin use is associated with a beneficial effect on all-cause mortality in COPD, depending on the baseline level of systemic inflammation.

Strategies to decrease ongoing oxidant burden in chronic obstructive pulmonary disease

Chronic obstructive pulmonary disease (COPD) is a leading cause of mortality and morbidity globally, and its development is mainly associated with tobacco/biomass smoke-induced oxidative stress. Hence, targeting systemic and local oxidative stress with agents that can balance the antioxidant/redox system can be expected to be useful in the treatment of COPD. Preclinical and clinical trials have revealed that antioxidants/redox modulators can detoxify free radicals and oxidants, control expression of redox and glutathione biosynthesis genes, chromatin remodeling and inflammatory gene expression; and are especially useful in preventing COPD exacerbations. In this review, various novel approaches and problems associated with these approaches in COPD are reviewed.

Beta-blocker use and COPD mortality: a systematic review and meta-analysis

Background

Despite the benefits of beta-blockers in patients with established or sub-clinical coronary artery disease, their use in patients with chronic obstructive pulmonary disease (COPD) has been controversial. Currently, no systematic review has examined the impact of beta-blockers on mortality in COPD.

Methods

We systematically searched electronic bibliographic databases including MEDLINE, EMBASE and Cochrane Library for clinical studies that examine the association between beta-blocker use and all cause mortality in patients with COPD. Risk ratios across studies were pooled using random effects models to estimate a pooled relative risk across studies. Publication bias was assessed using a funnel plot.

Results

Our search identified nine retrospective cohort studies that met the study inclusion criteria. The pooled relative risk of COPD related mortality secondary to beta-blocker use was 0.69 (95% CI: 0.62-0.78; I₂=82%).

Conclusion

The results of this review are consistent with a protective effect of beta-blockers with respect to all cause mortality. Due to the observational nature of the included studies, the possibility of confounding that may have affected these results cannot be excluded. The hypothesis that beta blocker therapy might be of benefit in COPD needs to be evaluated in randomised controlled trials.