Statin Use and the Risk of Subsequent Hospitalized Exacerbations in COPD Patients with Frequent Exacerbations
Received 28 August 2019
Accepted for publication 10 January 2020
Published 10 February 2020 Volume 2020:15 Pages 289—299
Checked for plagiarism Yes
Review by Single-blind
Peer reviewer comments 4
Editor who approved publication: Prof. Dr. Chunxue Bai
Chieh-Mo Lin, 1, 2 Tsung-Ming Yang, 1 Yao-Hsu Yang, 3–5 Ying-Huang Tsai, 6, 7 Chuan-Pin Lee, 4 Pau-Chung Chen, 8–11 Wen-Cheng Chen, 12 Meng-Jer Hsieh 1, 7
1Department of Pulmonary and Critical Care Medicine, Chiayi Chang Gung Memorial Hospital, Chang Gung Medical Foundation, Chiayi, Taiwan; 2Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan City, Taiwan; 3Department of Traditional Chinese Medicine, Chiayi Chang Gung Memorial Hospital, Chang Gung Medical Foundation, Chiayi, Taiwan; 4Health Information and Epidemiology Laboratory of Chang Gung Memorial Hospital, Chang Gung Medical Foundation, Chiayi, Taiwan; 5School of Traditional Chinese Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan; 6Department of Pulmonary and Critical Care Medicine, Linkou Chang Gung Memorial Hospital, Chang Gung Medical Foundation, Taoyuan, Taiwan; 7Department of Respiratory Therapy, School of Medicine, Chang Gung University, Taoyuan, Taiwan; 8Institute of Environmental and Occupational Health Sciences, National Taiwan University College of Public Health, Taipei, Taiwan; 9Department of Public Health, National Taiwan University College of Public Health, Taipei, Taiwan; 10Department of Environmental and Occupational Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan; 11Office of Occupational Safety and Health, National Taiwan University Hospital, Taipei, Taiwan; 12Department of Radiation Oncology, Chiayi Chang Gung Memorial Hospital, Chang Gung Medical Foundation, Chiayi, Taiwan
Correspondence: Meng-Jer Hsieh
Department of Pulmonary and Critical Care Medicine, Chiayi Chang Gung Memorial Hospital, Chang Gung Medical Foundation, No. 6, West Sec., Jiapu Road, Puzi City, Chiayi County 61363, Taiwan
Rationale: The potential benefits of statins for the prevention of exacerbations in patients with COPD remains controversial. No previous studies have investigated the impact of statins on clinical outcomes in COPD patients with frequent exacerbations.
Objective: This study aimed to evaluate the association between the use of statins and the risk of subsequent hospitalized exacerbations in COPD frequent exacerbators.
Materials and Methods: We conducted a population-based cohort study using the Taiwan National Health Insurance Research Database. 139,223 COPD patients with a first hospitalized exacerbation between 2004 and 2012 were analyzed. Among them, 35,482 had a second hospitalized exacerbation within a year after the first exacerbation, and were defined as frequent exacerbators. 1:4 propensity score matching was used to create matched samples of statin users and non-users. The competing risk regression analysis model was used to evaluate the association between statin use and exacerbation risk.
Results: The use of statins was associated with a significantly reduced risk in subsequent hospitalized exacerbations in COPD patients after their first hospitalized exacerbation (adjusted subdistribution hazard ration [SHR], 0.89; 95% CI, 0.85– 0.93, P< 0.001). In frequent exacerbators, the SHR for subsequent hospitalized exacerbations in statins users was 0.88 (95% CI, 0.81– 0.94, P=0.001). Subgroup analysis among frequent exacerbators demonstrated that the use of statins only provided a protective effect against subsequent hospitalized exacerbations in male patients aged 75 years and older, with coexisting diabetes mellitus, hypertension or cardiovascular disease, and no protective effect was observed in those with lung cancer or depression. Current use of statins was associated with a greater protective effect for reducing subsequent hospitalized exacerbation.
Conclusion: The use of statins was associated with a significant reduction in the risk of hospitalized exacerbations in COPD patients after a first hospitalized exacerbation and in specified COPD frequent exacerbators.
Keywords: chronic obstructive pulmonary disease, statin, exacerbation, frequent exacerbator
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