Statin Use and Risk of COPD Exacerbation Requiring Hospitalization

doi:10.1016/j.amjmed.2013.01.036

The American Journal of Medicine

Volume 126, Issue 7, July 2013, Pages 598-606.e2

https://doi.org/10.1016/j.amjmed.2013.01.036 Get rights and content

Abstract

Background

Despite recent studies that suggested statins' beneficial effects on chronic obstructive pulmonary disease (COPD) outcomes, the impact, if any, of statins on COPD exacerbations remains unclear. This study aimed to examine the association between statin use and risk of hospitalized COPD exacerbation, and to assess whether the association varied by statin initiation, dose, or duration of use.

Methods

A retrospective nested case-control study among patients with COPD was conducted analyzing a nationwide health insurance claims database in Taiwan. Cases were subjects hospitalized for COPD exacerbations; each case was matched to 4 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 1584 cases with COPD exacerbations and 5950 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

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.

Section snippets

Data Source

This study employed a population-based nested case-control study design using data from the Longitudinal Health Insurance Database (LHID) from January 1, 2000 to December 31, 2008. The LHID is constructed from all claims for payment in the Taiwan National Health Insurance (NHI) program, in which up to 99% of the 23 million inhabitants of Taiwan are enrolled.²⁰ The LHID contains all transactions of de-identified and encrypted medical and pharmacy claims from any inpatient, outpatient, and

Results

The study cohort comprised 14,316 COPD patients over the 8-year study period (Figure 1); they were aged 67.7 years, on average, and were cumulatively followed for 63,657 patient-years. After exclusion of 41 cases without any corresponding matched control, a total of 1584 case patients and 5950 matched controls were retrieved and analyzed. The mean follow-up period, from cohort entry to the index date, was 2.3 years for cases and 2.5 years for controls. Additionally, among 9.0% of cases and

Discussion

In this population-based nested case-control study, any use of statins is found to be associated with a 30% reduction in the risk of hospitalization for COPD exacerbation. The protective effect of statins on COPD exacerbations is more profound for statins used within 6 months, or for statins prescribed at medium or high average daily dose. This observational study revealed that statin use might be beneficial in COPD patients.

Previous studies examining statin use in relation to COPD exacerbations

Acknowledgment

We thank the Bureau of National Health Insurance and the National Health Research Institutes for providing the database. The interpretation and conclusions contained herein do not represent those of the above-mentioned institutes. We also appreciate Ms. Bi-Juian Wu for the assistance in cleaning the datasets.

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: Funding: None.

: Conflict of Interest: DCM had served as a consultant for Strategic Therapeutics, LLC, a health care consulting firm that has provided services to Pfizer; the other authors had no potential conflict of interest to declare.

: Authorship: All authors had access to the data and played a role in writing this manuscript.

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Clinical research studyStatin Use and Risk of COPD Exacerbation Requiring Hospitalization

Abstract

Background

Methods

Results

Conclusions

Section snippets

Data Source

Results

Discussion

Acknowledgment

Lancet

Lancet

Chest

Am J Cardiol

J Am Coll Cardiol

Clin Ther

Pulm Pharmacol Ther

Chest

Int J Cardiol

Chest

Atherosclerosis

Chest

Trends in COPD mortality and hospitalizations in countries and regions of Asia-Pacific

Respirology

Trends in hospitalization with chronic obstructive pulmonary disease-United States, 1990-2005

COPD

Pharmacological actions of statins: potential utility in COPD

Eur Respir Rev

Lovastatin enhances clearance of apoptotic cells (efferocytosis) with implications for chronic obstructive pulmonary disease

J Immunol

Reversal of elastase-induced pulmonary emphysema and promotion of alveolar epithelial cell proliferation by simvastatin in mice

Am J Physiol Lung Cell Mol Physiol

Cholesterol-independent effects of statins in inflammation, immunomodulation and atherosclerosis

Curr Drug Targets Cardiovasc Haematol Disord

Clinical research study
Statin Use and Risk of COPD Exacerbation Requiring Hospitalization