Statins and morbidity and mortality in COPD in the COMIC study: a prospective COPD cohort study

Abstract

BackgroundBoth chronic inflammation and cardiovascular comorbidity play an important role in the morbidity and mortality of patients with chronic obstructive pulmonary disease (COPD). Statins could be a potential adjunct therapy. The additional effects of statins in COPD are, however, still under discussion. The aim of this study is to further investigate the association of statin use with clinical outcomes in a well-described COPD cohort.Methods795 patients of the Cohort of Mortality and Inflammation in COPD (COMIC) study were divided into statin users or not. Statin use was defined as having a statin for at least 90 consecutive days after inclusion. Outcome parameters were 3-year survival, based on all-cause mortality, time until first hospitalisation for an acute exacerbation of COPD (AECOPD) and time until first community-acquired pneumonia (CAP). A sensitivity analysis was performed without patients who started a statin 3 months or more after inclusion to exclude immortal time bias.ResultsStatin use resulted in a better overall survival (corrected HR 0.70 (95% CI 0.51 to 0.96) in multivariate analysis), but in the sensitivity analysis this association disappeared. Statin use was not associated with time until first hospitalisation for an AECOPD (cHR 0.95, 95% CI 0.74 to 1.22) or time until first CAP (cHR 1.1, 95% CI 0.83 to 1.47).ConclusionsIn the COMIC study, statin use is not associated with a reduced risk of all-cause mortality, time until first hospitalisation for an AECOPD or time until first CAP in patients with COPD.

Statins in High-Risk Chronic Obstructive Pulmonary Disease Outpatients: No Impact on Time to First Exacerbation and All-Cause Mortality – The STATUETTE Cohort Study

“…In the positive study by Ingebrigtsen et al, 11 the study setting was primarily primary care, whereas the COMIC 29 and STATUETTE cohorts were both conducted on moderate-to-high-risk COPD patients from a secondary care setting. Ingebrigtsen et al 11 suggest that COPD patients with coexisting CVD as a potential target-population for statin treatment, but both the COMIC 29 and STATUETTE cohorts contain a high burden of CVD comorbidity and as such cannot be the sole explanation for the diverging results. While CVD underdiagnosis could be more prevalent in a general COPD population than in specialized care, it is unlikely to drive the observed positive association.…”

<p>Management of the COPD Patient with Comorbidities: An Experts Recommendation Document</p>

“…74 Another study found no association between statin use, reduction of all-cause mortality, time to first hospitalization for exacerbation, or time to first pneumonia. 75 A meta-analysis of 10 randomized clinical trials studying the effect of statins in COPD patients showed an improvement in exercise tolerance, lung function, and quality of life in COPD patients with a history of cardiovascular disease treated with statins. 76 Given this evidence, our conclusions and recommendations about dyslipidemia in COPD patients are shown in Supplementary Table 2D.…”

Do outpatient statins and ACEIs/ARBs have synergistic effects in reducing the risk of pneumonia? A population-based case-control study

“…One study reported that statins reduced the risk of hospitalization for pneumonia in myocardial infarction patients [ 15 ]. In a cohort study, statin use was not associated with reduced time until the first community-acquired pneumonia occurred in patients with COPD [ 16 ]. Although discordant results were exhibited among current studies, exploration of the effects against infectious diseases has garnered significant attention in clinical studies because of the easy availability of these medications and their applicability in the clinic.…”