Statin Use Reduces Decline in Lung Function. Introduction Lung function has been shown to predict...
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Transcript of Statin Use Reduces Decline in Lung Function. Introduction Lung function has been shown to predict...
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
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 (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 (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)
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.