Statin Therapy is Associated with Decreased Pulmonary Vascular Pressures in Severe COPD

Figures & data

Table 1  Clinical characteristics of study subjects

	Entire Cohort	Statin [-] (N = 78)	Statin [+] (N = 34)	p-value^†
Age (years)	58 (8)	55 (9)	58 (6)	*
Male	41%	37%	50%	NS
Caucasian	86%	81%	97%	*
BMI	24 (5)	24 (5)	25 (5)	NS
Tobacco exposure (pack-years)	53 (29)	52 (31)	56 (22)	NS
Comorbidity
Diabetes mellitus	11%	12%	9%	NS
CHF history	7%	8%	6%	NS
DVT/PE history	5%	5%	6%	NS
Hypertension	44%	35%	65%	**
Hyperlipidemia	29%	5%	85%	***
CAD^††	19%	9%	41%	***
Medications
Theophylline	41%	42%	38%	NS
ACE/ARB	14%	12%	21%	NS
Calcium channel blocker use	27%	19%	44%	**
Diuretic use	24%	24%	24%	NS
Lipid Profile
Total chol (mg/dL)	217 (51)	216 (49)	218 (57)	NS
TG (mg/dL)	131 (105)	130 (105)	133 (106)	NS
LDLc (mg/dL)	113 (39)	114 (36)	113 (46)	NS
HDLc (mg/dL)	76 (29)	76 (29)	77 (31)	NS
Pulmonary Function
Supplemental O2 use	90%	88%	91%	NS
O2 use (liters per minute)	2.6 (1.3)	2.7 (1.4)	2.2 (1.1)	*
PaCO2 (mmHg)	49 (12)	50 (13)	46 (7)	NS
FVC%	47 (14)	45% (14)	50 (15)	*
FEV1%	21 (8)	21% (8)	22% (7)	NS
FEV1/FVC	36 (9)	37% (9)	34% (9)	NS
TLC%	114 (22)	113% (24)	117% (16)	NS
VC%	59 (18)	58% (17)	62% (21)	NS
RV%	212 (59)	212% (67)	211% (33)	NS
RV/TLC	66 (9)	66% (10)	66 (7)	NS
6MWD (meters) (n = 60)	249 (111)	243 (120)	259 (94)	NS
Pulmonary Hemodynamics
CI (l/min/m^2 BSA)	2.9 (0.7)	2.9 (0.7)	2.8 (0.6)	NS
RAP (mmHg)	9.8 (5)	10.3 (5)	8.6 (5)	NS
mPAP (mmHg)	28 (7)	29 (7)	26 (7)	*
PAWP (mmHg)	14 (5)	15(5)	12 (6)	*
PVRI (Wood units/m^2 BSA)	5 (2.3)	5.0 (2.2)	5.0 (2.6)	NS

Values presented are means with SD in parentheses.

^†p value refers to the difference between statin groups.

^††Defined as ≥ 50% stenosis in left main coronary, ≥ 70% elsewhere, or intervention performed. CI = Cardiac index, RAP = Right atrial pressure, mPAP = mean pulmonary arterial pressure, PAWP = pulmonary arterial wedge pressure, PVRI = pulmonary vascular resistance index.

* p ≤ 0.05.

**p ≤ 0.01.

***P ≤ 0.005.

Figure 1  Scatterplot with Pearson's Correlation Between Pulmonary Arterial Wedge Pressure and Mean Pulmonary Arterial Pressures.

Table 2  Regression models of correlates to pulmonary artery wedge pressure

	PAWP
	β	95% CI	p- value
Univariate Analysis
• BMI	0.43	0.24 to 0.63	<0.001***
• Non-Caucasian Race	3.2	0.4 to 5.9	0.024
• Statin	−2.3	−4.4 to −0.1	0.037
• Age	0.09	−0.03 to 0.22	0.149
• Female Gender	−0.9	−3.0 to 1.1	0.359
• CAD^†	−0.2	−2.8 to 2.5	0.899
• FEV1% predicted	−0.09	−0.23 to 0.04	0.174
• Hypertension	1.2	−0.8 to 3.2	0.226
• Diuretic use	0.8	−1.6 to 3.2	0.500
• Ca^++ channel blocker use	−0.5	−2.7 to 1.8	0.686
• O2 use (liters per minute)	-.2	−0.4 to 1.1	0.409
Reverse Stepwise Regression Model^††
• Statin	−4.2	−6.4 to −2.0	<0.001***
• BMI	0.39	0.20 to 0.58	<0.001***
• Age	0.13	−0.01 to 0.28	0.067
• Non-Caucasian Race	2.0	−0.8 to 4.7	0.158
• Hypertension	1.4	−0.6 to 3.4	0.160
• O2 use (liters per minute)	−0.5	−0.13 to 0.2	0.169

^†Defined as in Table 1.

^††Variables evaluated included statin use, age, race, BMI, CAD, HTN, calcium channel blocker use, diuretic use, and oxygen use in liters per minute.

*p ≤ 0.05.

**p ≤ 0.01.

***P ≤ 0.005.

Table 3  Regression models of correlates to mean pulmonary artery pressure

	mPAP
	β	95% CI	p-value
Univariate Analysis
• PAWP	0.8	0.6 to 1.0	<0.001***
• Age	0.29	0.13 to 0.45	<0.001***
• BMI	0.45	0.18 to 0.71	0.001***
• Non-Caucasian Race	4.6	0.9 to 8.2	0.015
• Statin	−2.9	−5.8 to −0.1	0.040
• Female Gender	−1.8	−4.5 to 0.8	0.179
• CAD^†	0.4	−3.3 to 4	0.841
• FEV1% predicted	−0.04	−0.22 to 0.14	0.663
• Hypertension	1.6	−1.0 to 4.3	0.224
• Diuretic use	2.0	−1.1 to 5.0	0.202
• Ca^++ channel blocker use	−0.9	−3.9 to 2.1	0.549
• O2 use (liters per minute)	1.0	−0.05 to 2.0	0.063
Reverse Stepwise Regression Model^††
• PAWP	0.59	0.37 to 0.82	<0.001***
• Age	0.27	0.14 to 0.41	<0.001***
• Statin	−2.6	−4.9 to −0.3	0.028
• BMI	0.28	0.05 to 0.51	0.019

^†Defined as in Table 1.

^††Variables evaluated included statin use, PAWP, BMI, age, race, calcium channel blocker use, and oxygen use in liters per minute.

*p ≤ 0.05.

**p ≤ 0.01.

***P ≤ 0.005.

Table 4  Regression models of correlates to mean pulmonary artery pressure and pulmonary artery wedge pressure

	mPAP			PAWP
	β	95% CI	p-value	β	95% CI	p-value
Fully Adjusted Model
• Statin	−5.2	−8.5 to −1.9	***	−4.3	−6.6 to −2	***
• BMI	0.56	0.25 to 0.86	***	0.44	0.22 to 0.66	***
• Age	0.34	0.10 to 0.57	**	−0.003	−0.17 to 0.16	NS
• Gender	−1.4	−4.3 to 1.5	NS	−0.2	−2.3 to 1.9	NS
• Race	0.8	−3.6 to 5.2	NS	−0.4	−3.5 to 2.7	NS
• CAD^†	1.5	−2.6 to 5.5	NS	0.3	−2.6 to 3.2	NS
• FEV1% predicted	−0.09	−0.26 to 0.09	NS	−0.13	−0.25 to −0.01	*
• DLCO% predicted	−0.02	−0.10 to 0.06	NS	0.04	−0.02 to 0.09	NS
• Hypertension	−1.5	−5.5 to 2.4	NS	1.8	−0.9 to 4.6	NS
• Diuretic use	1.0	−2.4 to 4.3	NS	−1.4	−3.8 to 1.1	NS
• Ca^++ channel blocker use	1.4	−2.9 to 5.8	NS	−0.8	−3.9 to 2.3	NS

^†Defined as ≥50% stenosis in left main coronary, ≥70% elsewhere, or intervention performed.

*p ≤ 0.05.

**p ≤ 0.01.

***P ≤ 0.005.