Update on the potential role of statins in chronic obstructive pulmonary disease and its co-morbidities

Abstract

Chronic obstructive pulmonary disease (COPD) is soon to become the third leading cause of death in developed countries. COPD is increasingly considered a multisystem disease characterized by both pulmonary and systemic inflammation. Over the last 5 years, there have been a growing number of studies showing that the cholesterol-lowering drugs statins (HMG-CoA reductase inhibitors) have a beneficial effect in patients with COPD. While statins are known to have a number of pharmacological effects (pleiotropy) that could explain these benefits, it is currently not clear which effects are most relevant in COPD. This article reviews the most recently published studies of statin therapy in patients with COPD, focusing on the important COPD co-morbidities of the pulmonary system (infective exacerbations, pneumonia, influenza and lung cancer) and cardiovascular system (acute coronary syndrome, endothelial dysfunction and pulmonary hypertension). While we await the results of randomized controlled trials, there continues to be consistent (albeit indirect) evidence from observational studies suggesting statins are beneficial for patients with COPD, conferring important pharmacological effects on inflammation not conferred by current inhaler-based therapies.

Keywords::

• chronic obstructive pulmonary disease
• co-morbidities
• HMG-CoA reductase inhibitors
• lung cancer
• pneumonia, smokers
• spirometry
• statins

Financial & competing interests disclosure

RP Young, and the funding of his research, has been supported by grants from the University of Auckland, Health Research Council of New Zealand and Synergenz BioSciences Ltd. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

No writing assistance was utilized in the production of this manuscript.

Key issues

• • Chronic obstructive pulmonary disease (COPD) is characterized by varying degrees of exaggerated pulmonary and systemic inflammation that play an important role in the natural history of this disease.

• • Current therapies in COPD target only the pulmonary features of COPD with little or no effect on the natural history of COPD or its co-morbid complications.

• • Results from numerous observational studies consistently show clinically important benefits for COPD patients taking statins compared with those not taking them.

• • Systemic inflammation has been implicated in worse outcomes for both pulmonary and systemic complications of COPD. Data from recently published statin studies suggest that reducing these inflammatory processes could explain these benefits of statins.

• • Randomized controlled trials are urgently needed to establish whether statin therapy should become a routinely used adjunct therapy in patients with COPD, identifying which subgroup might benefit most.

Notes