Statin Use and the Risk of Subsequent Hospitalized Exacerbations in COPD Patients with Frequent Exacerbations

Chieh-Mo Lin; Tsung-Ming Yang; Yao-Hsu Yang; Ying-Huang Tsai; Chuan-Pin Lee; Pau-Chung Chen; Wen-Cheng Chen; Meng-Jer Hsieh

doi:10.2147/COPD.S229047

Statin Use and the Risk of Subsequent Hospitalized Exacerbations in COPD Patients with Frequent Exacerbations

Int J Chron Obstruct Pulmon Dis. 2020 Feb 10:15:289-299. doi: 10.2147/COPD.S229047. eCollection 2020.

Authors

Chieh-Mo Lin^{1

2}, Tsung-Ming Yang¹, Yao-Hsu Yang^{3

4

5}, Ying-Huang Tsai^{6

7}, Chuan-Pin Lee⁴, Pau-Chung Chen^{8

9

10

11}, Wen-Cheng Chen¹², Meng-Jer Hsieh^{1

7}

Affiliations

¹ Department of Pulmonary and Critical Care Medicine, Chiayi Chang Gung Memorial Hospital, Chang Gung Medical Foundation, Chiayi, Taiwan.
² Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan City, Taiwan.
³ Department of Traditional Chinese Medicine, Chiayi Chang Gung Memorial Hospital, Chang Gung Medical Foundation, Chiayi, Taiwan.
⁴ Health Information and Epidemiology Laboratory of Chang Gung Memorial Hospital, Chang Gung Medical Foundation, Chiayi, Taiwan.
⁵ School of Traditional Chinese Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan.
⁶ Department of Pulmonary and Critical Care Medicine, Linkou Chang Gung Memorial Hospital, Chang Gung Medical Foundation, Taoyuan, Taiwan.
⁷ Department of Respiratory Therapy, School of Medicine, Chang Gung University, Taoyuan, Taiwan.
⁸ Institute of Environmental and Occupational Health Sciences, National Taiwan University College of Public Health, Taipei, Taiwan.
⁹ Department of Public Health, National Taiwan University College of Public Health, Taipei, Taiwan.
¹⁰ Department of Environmental and Occupational Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan.
¹¹ Office of Occupational Safety and Health, National Taiwan University Hospital, Taipei, Taiwan.
¹² Department of Radiation Oncology, Chiayi Chang Gung Memorial Hospital, Chang Gung Medical Foundation, Chiayi, Taiwan.

Abstract

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; exacerbation; frequent exacerbator; statin.

Publication types

Observational Study

MeSH terms

Adult
Aged
Aged, 80 and over
Databases, Factual
Disease Progression
Female
Hospitalization*
Humans
Hydroxymethylglutaryl-CoA Reductase Inhibitors / adverse effects
Hydroxymethylglutaryl-CoA Reductase Inhibitors / therapeutic use*
Male
Middle Aged
Prognosis
Pulmonary Disease, Chronic Obstructive / diagnosis
Pulmonary Disease, Chronic Obstructive / drug therapy*
Respiratory System Agents / adverse effects
Respiratory System Agents / therapeutic use*
Retrospective Studies
Risk Assessment
Risk Factors
Taiwan
Time Factors

Substances

Hydroxymethylglutaryl-CoA Reductase Inhibitors
Respiratory System Agents

Grants and funding

This study was supported by a grant from Chiayi Chang Gung Memorial Hospital, Taiwan (grant no. CORPG6D0211).