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Statin Use and Risk of COPD Exacerbation Requiring Hospitalization
Study Questions:
Is there a relationship between statin use and risk of hospitalized chronic obstructive pulmonary disease (COPD) exacerbation, and does the association vary by statin initiation, dose, or duration of use?
Methods:
A retrospective nested case-control study was conducted among patients with COPD utilizing a nationwide health insurance claims database in Taiwan. Cases were subjects hospitalized for COPD exacerbations; each case was matched to four randomly selected controls on age, sex, cohort entry, and number of COPD-related outpatient visits by an incident-density sampling approach. Conditional logistic regressions were employed to quantify the COPD exacerbation risk associated with statin use.
Results:
The study cohort comprised 14,316 COPD patients, from which 1,584 cases with COPD exacerbations and 5,950 matched controls were identified. Any use of statins was associated with a 30% decreased risk of COPD exacerbation (95% confidence interval [CI], 0.56-0.88), and current use of statins was related to a greater reduced risk (adjusted odds ratio [OR], 0.60; 95% CI, 0.44-0.81). A dose-dependent reduced risk of COPD exacerbation by statins was observed (medium average daily dose: adjusted OR, 0.60; 95% CI, 0.41-0.89; high daily dose: adjusted OR, 0.33; 95% CI, 0.14-0.73). The reduced risk remained significant for either short or long duration of statin use.
Conclusions:
The authors concluded that statin use was associated with a reduced risk of COPD exacerbation, with a further risk reduction for statins prescribed more recently or at high doses.
Perspective:
While there are no randomized clinical trials, observational studies report that statin use in COPD is associated with a 28-40% reduced risk of hospitalization, a 10-fold decrease in the risk for intubation, and >50% decreased mortality. This study adds to the likely value of statins in COPD by demonstrating the value of recent active use and of higher dosing. The study value is limited, having been conducted in a specific Asian population with COPD treatment using less inhaled steroids and more theophylline than North America and Europe.
Keywords: Hydroxymethylglutaryl-CoA Reductase Inhibitors, Taiwan, Lung Diseases
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