The Role Of Statins In Treatment Of Patients With Chronic Obstructive Pulmonary Disease:A Meta-analysis And Systematic Review

Background:Previous studies showed that patients with chronic obstructive pulmonary disease(COPD)are at high risk for cardiovascular events,COPD patients with cardiovascular disease have poorer prognosis,short-and long-term survival rates significantly decrease.Some observational studies have suggested that statins treatment may reduce mortality in patients suffering from chronic obstructive pulmonary disease.However,several other studies fail to draw similar conclusions.We performed a systematic review and meta-analysis including patients with COPD to determine whether use of statins was associated with beneficial effects on COPD outcomes.Methods:The PubMed,Embase,Web of Science,The Cochrane Library,CBM,CNKI were searched to identify cohort studies that investigated the effects of statins treatment on COPD outcomes.The primary endpoint was all-cause mortality.The second outcomes were COPD mortality,cardiovascular mortality,cancer mortality,COPD exacerbations.The odds ratio(OR)with 95% confidence intervals(CIs)were pooled using a random-effects model.Egger linear regression testing was performed to test for publication bias.Sensitivity analyses and subgroup analyses were also conducted.Results:19 studies with a total of 181,911 COPD patients were included.13 articles provided data on all-cause mortality(67,099 participants),and they gave an OR of 0.67(95% CI 0.61 to 0.75)using a random-effects model;Three studies provided data on cancer mortality(13,549 participants),they gave an OR of 0.61(0.50 to 0.75)using a random-effects model;2 studies on COPD mortality(77,919 participants),they gave an OR of 0.42(0.23 to 0.78)using a random-effects model;and 3 studies on cardiovascular mortality(4,425 participants),they gave an OR of 0.55(0.34 to 0.90)using a random-effects model;4 articles provided data on COPD exacerbation(32,294 participants),they gave an OR of 0.67(0.61 to 0.73)using a random-effects model.Conclusions:The use of statins for patients suffering from chronic obstructive pulmonary disease may reduce all-cause mortality,cancer mortality,COPD mortality,cardiovascular mortality,COPD exacerbation.The immune modulating and anti-inflammatory actions of statins might be the plausible mechanism accounting for these positive relationship.This conclusion should be tested by large-scale,well-designed randomized controlled trials.