Statin Use Reduces Decline in Lung Function. Introduction Lung function has been shown to predict both cardiovascular mortality and total mortality.

Statin Use Reduces Decline in Lung Function

Introduction

Lung function has been shown to predict both cardiovascular mortality and total mortality in patient with COPD

Higher decline rate association with increased mortality and hospital stay related to COPD

Inflammation and oxidative stress are considered important to the development of COPD.

Introduction

Statin has anti-inflammatory and antioxidant effects

Statins have been shown to reduce serum CRP level, reduce oxidative stress

Introduction

This study examines: 1.whether the use of statin affects the rate of lung fun

ction decline in the elderly. 2.whether smoking history modified this effect of stati

n

Method

Subjects in this study were part of the Veterans Administration Normative aging study.

Our study were 803/2280 whose lung function were measured 2-4 times during 1995-2005.

Method-study

Visit: overnight fasting and absence of smoking.

Exams: height and lung function( FVC, FEV1)

Pulmonary disorders indicated by questionnaire based on American Thoracic Society

Division of Lung Disease 1978 questionnaire, including smoking habits and medication use

Confirmed by interviewers

Presentation

Choose the variables above and included them in all of our models.

Measurement of FVC and FEV1 were taken 2-4 times for each subject.

Mixed linear model was used P value <0.05 was considered significant

Presentation

Decline in lung function: Change in milliliters per year of FVC and FEV1 ∆yrs X (β+ 1.96 X SE) ∆yrs is change in years β is the estimated regression coefficient for time

Results

Results

1. statin users had more CAD than nonusers, but it differed little

2. lung function was lower. Because the statins use was increased over time. So it was measured at older age. Models with control of age or time are required

for this 3. few subjects were black, same result with

all white.

Results

The same results were got when excluding subjects(3%) using bronchodilator or steroid.

Results (adjusted )

Effect by statin use

Change in FEV1(ml/yr)

95% CI Change in FVC (ml/yr)

95% CI

Not using statins

-23.9 -27.8 to -20.1 -36.2 -41.5 to -30.8

Using statings

-10.9 -16.9 to -5.0 -14.0 -22.2 to -5.9

Results (unadjusted)

Results (smoking)

1.divided smokers into four groups 1.never 2.longtime quitters(>10yrs) 3.recent

quitters(<10 yrs) 4.current smokers. 2.changes in FEV1 and FVC

Results (smoking)

Results (smoking)

Weakly suggest that longtime quitters and recent quitters may be able to benefit more from statin use than other groups.

Discussion

Suggest potential benefit of reducing decline in lung function related to statins users

Longtime and recent quitters seemed to benefit more from statin use. More study with current smoker is needed.

Pointing to a potential treatment of COPD in addition to stopping smoking.

Well designed clinical trial is needed to confirm the size of effect of statins

Discussion

An abstract publish for chest 2006 conference— reduces decline in FVC and FEV1 for the statin users, compared between current and former smokers.

Another study suggest that statin use in for lung transplantation recipients improved lung function and lower percentage of neutrophils and lymphocytes in BAL fluid.

Discussion

Animal study have found that statins reduce neutrophil level in lung tissue when lipopolysaccharides are used to induce inflammatory response of lung

Study on rat : statin protected against smoking-induced lung damage

Statins have been shown to suppress the concentration of Th1, IFN-r, NK cell, and IL-8 by human tissue

Discussion

Study showed that statin users have lower serum CRP level.

Inverse relationship between CRP and lung function. Increased CRP levels were associated with greater declines in FEV1.

NADPH oxidase produce reactive oxygen species in lung to make oxidative stress. Statins have been shown to inhibit activation of NADPH oxidase in monocyte.

Discussion

Limitation of study: All elderly men, most were white Fewer current smoker and recent quitters

Non-randomized clinical trial Statins were used to lower cholesterol, Estimate decline in lung function by CAD instead

of statin use=>no significant association

Discussion

Statin users may have more regular visit and more medication, especially steroid. The use was low, same estimates when Mx use was ex

cluded. Statin users may have engage in other health-c

onscious behavior.

Discussion

In table 1, lower FVC and FEV1 were found in statin users 1.because of higher mean age. 2.higher level of heart Dx and HTN=>β-blocker use. Ad

ding use of these Mx in our model did not change the estimated effect of statin.

Survivor bias:Very low lung function declines more slowly.Same data was obtained when excluding the lowest 5%

of lung function.

Discussion

1. RCT is needed to confirm the effect of statin

2.The beneficial effect of statin seems to be present regardless of smoking history

3.This research indicate the positive effect of statin use beyond its cholesterol-lowering properties.

Thank you for your attention!!