title: Impact of statins and ACE inhibitors on mortality after COPD exacerbations.
abstract: BACKGROUND
  The purpose of our study was to examine the association of prior outpatient use of statins and angiotensin converting enzyme (ACE) inhibitors on mortality for subjects >or= 65 years of age hospitalized with acute COPD exacerbations.
  
  
  METHODS
  We conducted a retrospective national cohort study using Veterans Affairs administrative data including subjects >or=65 years of age hospitalized with a COPD exacerbation. Our primary analysis was a multilevel model with the dependent variable of 90-day mortality and hospital as a random effect, controlling for preexisting comorbid conditions, demographics, and other medications prescribed.
  
  
  RESULTS
  We identified 11,212 subjects with a mean age of 74.0 years, 98% were male, and 12.4% of subjects died within 90-days of hospital presentation. In this cohort, 20.3% of subjects were using statins, 32.0% were using ACE inhibitors or angiotensin II receptor blockers (ARB). After adjusting for potential confounders, current statin use (odds ratio 0.51, 95% confidence interval 0.40-0.64) and ACE inhibitor/ARB use (0.55, 0.46-0.66) were significantly associated with decreased 90-day mortality.
  
  
  CONCLUSIONS
  Use of statins and ACE inhibitors prior to admission is associated with decreased mortality in subjects hospitalized with a COPD exacerbation. Randomized controlled trials are needed to examine whether the use of these medications are protective for those patients with COPD exacerbations.
authors.affiliation: VERDICT research unit, South Texas Veterans Health Care System, San Antonio, Texas, USA. mortensene@uthscsa.edu
authors.forename: Eric M
authors.initials: EM
authors.lastname: Mortensen
authors.forename: Laurel A
authors.initials: LA
authors.lastname: Copeland
authors.forename: Mary Jo V
authors.initials: MJ
authors.lastname: Pugh
authors.forename: Marcos I
authors.initials: MI
authors.lastname: Restrepo
authors.forename: Rosa Malo
authors.initials: RM
authors.lastname: de Molina
authors.forename: Brandy
authors.initials: B
authors.lastname: Nakashima
authors.forename: Antonio
authors.initials: A
authors.lastname: Anzueto
mesh_terms: D000368:Aged; D057911:Angiotensin Receptor Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use*; D015897:Comorbidity; D018450:Disease Progression; D005260:Female; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use*; D008297:Male; D011379:Prognosis; D029424:Pulmonary Disease, Chronic Obstructive / Q000401:mortality* / Q000503:physiopathology; D016019:Survival Analysis
chemical_list: D057911:Angiotensin Receptor Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors