P128 Cardiovascular Effects of Statin Therapy on Arterial Stiffness in Patients with COPD: A Double Blind Randomised Controlled Trial

Abstract

were no cannabis-only smokers and only 6/62 (9.7%) were never-smokers (tobacco&cannabis).56/62 (90%) abnormal HRCTs were in ex/current tobacco smokers and 27/62 (44%) were in current tobacco&cannabis smokers. There was a higher prevalence of pneumothoraces and bullae with a cannabis and tobacco smoking history than for tobacco alone but this was not statistically significant different (chi-squared STATA) (Table1). Conclusion More than half of tobacco smokers with abnormal HRCTs also had a history of previous and current cannabis smoking. Despite these findings 25% of patients with abnormal HRCTs had no documentation regarding cannabis smoking. This population of ≤50 years olds with abnormal HRCTs did not smoke cannabis without tobacco. While not statistically significant, bullae and pneumothoraces were more frequently observed in patients who smoked tobacco with cannabis compared to tobacco alone. Larger studies are needed to further understand the additive effect of cannabis smoking to tobacco-induced lung damage. These studies will require systematic recording of both tobacco and cannabis smoking histories. Background As cardiovascular disease is a comorbidity and major cause of death in patients with COPD, primary preventative strategies are required. Arterial stiffness, as measured by aortic pulse wave velocity (PWV) is increased in patients with COPD 1 , and is an independent predictor of cardiovascular risk 2 , which is modifiable over the short term. We hypothesised that aortic PWV, would be reduced by six weeks treatment of simvastatin 20mg once daily compared to placebo in selected patients with COPD without concurrent heart disease, diabetes or hypercholesterolemia. Methods Clinically stable patients with confirmed COPD were recruited and randomised to either simvastatin 20mg od (active) or placebo in double blinded fashion. Aortic PWV, blood pressure, spirometry, six minute walking distance, and lipids were measured pre-and post-6 weeks treatment. Primary analysis compared PWV between groups. A predefined subgroup analysis compared those with a baseline PWV≥10m/s. Results The patients were well matched for age, sex, smoking and lung function; active, n = 33 and placebo, n = 37. The recruitment target was met. Compliance was high with the active group achieving significantly lower total cholesterol -between arms mean (95% CI): -1.1 (-1.3, -0.8)mmol/L, p < 0.001. There was no significant change in aortic PWV after treatment in the active compared to placebo group: -0.7 (-1.8, 0.5)m/s, p = 0.24, In the subgroup with aortic PWV≥10m/s, n = 22, aortic PWV improved in the active arm compared to placebo: -2.8 (-5.2, -0.3)m/s, p = 0.03. This latter difference remained statistically significant after adjusting for age and sex. Blood pressure, lung function and six minute walking distance did not change. Conclusions In this pilot study, despite a significant reduction in total cholesterol there was no improvement in aortic PWV in patients with COPD taking simvastatin 20mg compared to placebo over 6 weeks. The p...

Effect of Statins on COPD

“…Ultimately, 10 of the 20 studies were selected 4-5, 11, 14-20 ; of those not included, three were excluded because they did not use a placebo control [21][22][23] , three because they used the same dataset as another study included in this meta-analysis [24][25][26] , one because it was a post-hoc analysis of a large statin-heart failure RCT 27 , one because one-quarter of the recruited patients did not complete the study 28 , one because most of the patients did not fulfil GOLD criteria for COPD 29 , and one because no outcomes of interest were reported 30 . All the included trials were published as peer-reviewed articles, and all of them were in English.…”