Effect of Statins on COPD

Zhang, Wen; Zhang, Yi; Li, Chuanwei; Jones, Paul; Wang, Chen; Fan, Yu

doi:10.1016/j.chest.2017.08.015

Cited by 48 publications

(22 citation statements)

References 40 publications

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“… 91 Analysis of data from the Multi-ethnic Study of Atherosclerosis lung study, 95 coupled with evidence from experimental studies, 96 indicates that ACE-inhibitors may have a role in limiting emphysema progression and lung function decline in patients whose COPD is characterized by endothelial dysfunction, 97 and a recent meta-analysis of 10 trials which examined the clinical efficacy of statin therapy in COPD concluded that statins may well benefit COPD patients with overt CVD. 98 …”

Section: Clinical Implicationmentioning

confidence: 99%

Defining the relationship between COPD and CVD: what are the implications for clinical practice?

Morgan

Zakeri

Quint

2018

Ther Adv Respir Dis

238

177

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Cardiovascular diseases (CVDs) are arguably the most important comorbidities in chronic obstructive pulmonary disease (COPD). CVDs are common in people with COPD, and their presence is associated with increased risk for hospitalization, longer length of stay and all-cause and CVD-related mortality. The economic burden associated with CVD in this population is considerable and the cumulative cost of treating comorbidities may even exceed that of treating COPD itself.Our understanding of the biological mechanisms that link COPD and various forms of CVD has improved significantly over the past decade. But despite broad acceptance of the prognostic significance of CVDs in COPD, there remains widespread under-recognition and undertreatment of comorbid CVD in this population. The reasons for this are unclear; however institutional barriers and a lack of evidence-based guidelines for the management of CVD in people with COPD may be contributory factors.In this review, we summarize current knowledge relating to the prevalence and incidence of CVD in people with COPD and the mechanisms that underlie their coexistence. We discuss the implications for clinical practice and highlight opportunities for improved prevention and treatment of CVD in people with COPD. While we advocate more active assessment for signs of cardiovascular conditions across all age groups and all stages of COPD severity, we suggest targeting those aged under 65 years. Evidence indicates that the increased risks for CVD are particularly pronounced in COPD patients in mid-to-late-middle-age and thus it is in this age group that the benefits of early intervention may prove to be the most effective.

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Section: Clinical Implicationmentioning

confidence: 99%

Defining the relationship between COPD and CVD: what are the implications for clinical practice?

Morgan

Zakeri

Quint

2018

Ther Adv Respir Dis

238

177

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“…Lastly, statins – commonly used in patients with CAD – may be helpful in treating coexisting COPD. 34 …”

Section: Discussionmentioning

confidence: 99%

Prevalence of undiagnosed COPD in male patients with coronary artery disease: a cross-sectional study in Jordan

Khassawneh¹,

Samrah²,

Jarrah³

et al. 2018

COPD

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PurposeCOPD and coronary artery disease (CAD) are common chronic diseases with shared risk factors. COPD continues to be largely underdiagnosed and undertreated. We aimed to describe the prevalence and predictors of undiagnosed COPD in Jordanian men with CAD.Patients and methodsIn a cross-sectional study conducted at a referral center in Jordan, male patients who underwent coronary angiography for suspected CAD and reported $10 pack-year of cigarette smoking were recruited. Pre- and post-bronchodilator spirometry was undertaken for all participants, and COPD was defined as post-bronchodilator FEV1/FVC <70%. The finding of ≥50% coronary luminal narrowing confirmed the presence of CAD.ResultsSpirometry was undertaken for 376 men with mean age of 56.02±10.55 years, and 72.6% were active cigarettes smokers with a mean pack-year of 55.89±34.25. A CAD diagnosis was confirmed in 300 (79.8%) men. Spirometric criteria for COPD were met in 76 (15.7%) patients, of whom 91.5% were not previously diagnosed. COPD-related symptoms were common: chronic cough (44.4%), dyspnea (66.2%), and wheezes (27.9%). COPD was more common in patients with (18.0%) compared to patients without (6.6%) CAD (P=0.014). Multivariate logistic regression showed that the risk of COPD was higher in patients with CAD (OR 3.16, 95% CI, 1.10–9.09, P=0.033) and in those with chronic bronchitis (OR 13.07, 95% CI, 6.69–25.52, P<0.001).ConclusionThere was a high prevalence of COPD among male patients with CAD and most were underdiagnosed despite having respiratory symptoms. Male smokers with CAD and respiratory symptoms should be evaluated for airflow limitation and the presence of COPD.

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“…A subsequent meta‐analysis of statins in COPD demonstrated that exercise capacity, lung function and quality of life were significantly improved in comparison to placebo, and patients with CVD were more likely to benefit . At present, the evidence does not support prescribing statins for COPD in the absence of standard indications; however, statins remain underprescribed in patients with COPD.…”

Section: Managementmentioning

confidence: 99%

Coexisting chronic obstructive pulmonary disease and cardiovascular disease in clinical practice: a diagnostic and therapeutic challenge

Leong

MacDonald

et al. 2019

Medical Journal of Australia

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C hronic obstructive pulmonary disease (COPD) is the cardinal smoking-related respiratory illness. 1,2 Diagnosis requires exposure to noxious inhalants, respiratory symptoms, and spirometry demonstrating airflow obstruction, defined by a post-bronchodilator forced expiratory volume in one second (FEV 1 ) divided by forced vital capacity ratio < 0.70. 1,2 COPD is the fifth leading cause of disability-adjusted life-years worldwide, affecting about 14% of Australians above the age of 40 years. 2 COPD has a profound impact on the Australian hospital system. In 2015-16, it was the most common cause of potentially preventable hospitalisations related to chronic conditions in Australia; it was followed by heart failure. 3 In Australian general practice, both respiratory presentations and cardiovascular issues are common, so co-occurrence is frequent. 4 Cardiovascular disease (CVD) has compelling links to COPD. Individuals with COPD have a nearly 2.5-fold risk of CVD in comparison with controls. 5 Moreover, patients with comorbid COPD and CVD report more breathlessness and worse quality of life, are more frequently hospitalised and have higher mortality than those with COPD alone. 6 More than a quarter of patients with COPD will die from a cardiovascular event, and 40% of patients with COPD and a cardiovascular history will die following a cardiovascular event. 6Despite this, under-diagnosis of CVD in patients with COPD is frequent. For example, in patients with COPD and electrocardiographic evidence of myocardial infarction, less than one-third had been diagnosed with CVD. 7 COPD and CVD share risk factors and symptoms with significant overlap in clinical presentations. Determining the presence and contributions of the individual diseases can help clinicians prognosticate and manage this complex population.We searched PubMed for COPD and cardiovascular terms. We examined clinically relevant aspects of their relationship, diagnostic challenges and current and future therapeutic strategies. COPD and CVD: shared pathophysiologyDisease processes in COPD and CVD overlap, and salient clinical aspects are outlined below. Shared risk factorsPatients with COPD generally have multiple major risk factors for CVD. They have almost invariably smoked, and tend to be older, male and less physically active (Box 1). Hypertension is highly prevalent and present in up to 77% of some COPD cohorts. 1,5 However, these are insufficient to explain the excess CVD prevalence seen in COPD. 6 1

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Effect of Statins on COPD

Abstract: PROSPERO: CRD42017060594; https://www.crd.york.ac.uk/PROSPERO/.

Cited by 48 publications

References 40 publications

Defining the relationship between COPD and CVD: what are the implications for clinical practice?

Defining the relationship between COPD and CVD: what are the implications for clinical practice?

Prevalence of undiagnosed COPD in male patients with coronary artery disease: a cross-sectional study in Jordan

Coexisting chronic obstructive pulmonary disease and cardiovascular disease in clinical practice: a diagnostic and therapeutic challenge

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