Effectiveness Of Using Statins In Chronic Obstructive Pulmonary Disease Patients With Pulmonary Hypertension-A Network Meta-analysis

Objective:Chronic obstructive pulmonary disease（COPD）with pulmonary hypertension（PH）seriously affects the quality of life and prognosis of patients.This study aims to evaluate the effect of statins in the treatment of COPD with PH,and compare the efficacy of different statins,so as to provide more accurate evidence for clinical practice.Methods:We searched Pub Med,Embase,Cochrane Library,CNKI,VIP,CBM and Wanfang database to find all Chinese and English literatures about statins in the treatment of COPD with pulmonary hypertension,and high-quality RCTs were extracted.The analyses were performed using Revman and Stata software.Results:48 RCT studies and 3812 patients were included in Network Meta-analysis.In terms of pulmonary arterial pressure improvement,four statins evaluated s PAP and two statins evaluated m PAP.Routine treatment was combined with atorvastatin（MD=-6.02,95%CI[-6.92,-5.12]）,risuvastatin（MD=-5.45,95%CI[-7.71,-3.19]）,fluvastatin（MD=-6.59,95%CI[-9.42,-3.77）,simvastatin（MD=-5.57,95%CI[-6.79,-4.36]）,The results showed that the decrease of s PAP was better than that of conventional treatment,and there were statistical differences.The results showed that the decrease of m PAP was better than that of conventional treatment,and there were statistical differences in the reduction of m PAP.In terms of exercise tolerance,three statins evaluated 6MWD,and the difference was statistically significant in the combination of atorvastatin（MD=47.20,95%CI[30.44,63.97]）,risuvastatin（MD=51.02,95%CI[14.96,87.08]）,simvastatin（MD=42.39,95%CI[19.74,65.04]）.In terms of lung function,the improvement of FVC was better than that of conventional treatment,and simvastatin was better than that of conventional treatment,and simvastatin was better than atorvastatin.The results showed that the combination of risuvastatin（MD=0.34,95%CI[0.28,0.40]）,atorvastatin（MD=0.25,95%CI[0.18,0.31]）and simvastatin（MD=0.24,95%CI[0.20,0.29]）were better than conventional treatment,and the difference was statistically significant;and rosuvastatin was better than simvastatin,and there were statistical differences.The results showed that the level of FEV1/FVC was better than that of conventional treatment,respectively,compared with conventional treatment,with atorvastatin（MD=6.66,95%CI[5.38,7.94]）,risuvastatin（MD=5.08,95%CI[3.48,6.69]）and simvastatin（MD=6.17,95%CI[3.13,9.22）].In terms of blood oxygen status,two statins were used to evaluate PO₂and PCO₂.The increase of the combined atorvastatin（MD=10.30,95%CI[7.39,13.22]）and simvastatin(MD=5.35,95%CI[3.05,7.65]PO₂was better than that of conventional treatment,and atorvastatin was better than simvastatin,which was statistically significant;simvastatin（MD=-4.45,95%CI[-7.27,-1.64]）,atorvastatin（md=-3.90,95%CI[-6.04）,-The decrease of PCO₂was better than that of conventional treatment,and there was statistical difference.Conclusion:Statins can reduce pulmonary artery pressure,improve exercise tolerance,lung function,and correct hypoxemia and carbon dioxide retention,and have a certain effect on patients with COPD and pulmonary hypertension.Because there are no significant differences between statins for multiple main outcome indicators,so this study did not show difference in efficacy between different statins。...