title: Statin use and exacerbations in individuals with chronic obstructive pulmonary disease.
abstract: BACKGROUND
  We tested the hypothesis that statin use in individuals with COPD is associated with a reduced risk of exacerbations.
  
  
  METHODS
  We identified 5794 individuals with COPD and a measurement of C reactive protein (CRP) in the Copenhagen General Population Study (2003-2008). During 3 years of follow-up we recorded exacerbations with hospital admissions or oral corticosteroid treatment. In a nested case-control design, matching on age, gender, smoking, COPD severity and comorbidity, we estimated the association between statin use and exacerbations. In addition, we examined the association between statin use and high CRP (>3 mg/L), and the association between high CRP and exacerbations during follow-up.
  
  
  RESULTS
  Statin use was associated with reduced odds of exacerbations in crude analysis, OR=0.68 (95% CI 0.51 to 0.91, p=0.01), as well as in multivariable conditional logistic regression analysis, OR=0.67 (0.48 to 0.92, p=0.01). However, in the subgroup with the most severe COPD and without cardiovascular comorbidity, we observed a null association between statin use and exacerbations, OR=1.1 (0.5 to 2.1, p=0.83). Furthermore, statin use was associated with reduced odds of a high CRP, OR=0.69 (0.56 to 0.85, p<0.001), and a high CRP was associated with an increased risk of exacerbations, HR=1.62 (1.35 to 1.94, p<0.001). We estimated the percentage of excess risk of the association of statin use with exacerbations possibly mediated through a reduction of CRP to be 14% (4-51%).
  
  
  CONCLUSIONS
  Statin use was associated with reduced odds of exacerbations in individuals with COPD from the general population, although this was not apparent in those with the most severe COPD without cardiovascular comorbidity. Statins may thus only associate with reduced risk of exacerbations in patients with COPD with coexisting cardiovascular disease.
authors.affiliation: Department of Respiratory Medicine, Odense University Hospital, and Institute of Clinical Research, University of Southern Denmark, Odense, Denmark The Copenhagen City Heart Study, Frederiksberg Hospital, Copenhagen, Denmark The Copenhagen General Population Study, Herlev Hospital, Copenhagen University Hospital, University of Copenhagen, Copenhagen, Denmark.
authors.forename: Truls S
authors.initials: TS
authors.lastname: Ingebrigtsen
authors.affiliation: The Copenhagen City Heart Study, Frederiksberg Hospital, Copenhagen, Denmark.
authors.forename: Jacob L
authors.initials: JL
authors.lastname: Marott
authors.affiliation: The Copenhagen City Heart Study, Frederiksberg Hospital, Copenhagen, Denmark The Copenhagen General Population Study, Herlev Hospital, Copenhagen University Hospital, University of Copenhagen, Copenhagen, Denmark Department of Clinical Biochemistry, Herlev Hospital, Copenhagen University Hospital, University of Copenhagen, Copenhagen, Denmark.
authors.forename: Børge G
authors.initials: BG
authors.lastname: Nordestgaard
authors.affiliation: The Copenhagen City Heart Study, Frederiksberg Hospital, Copenhagen, Denmark The Copenhagen General Population Study, Herlev Hospital, Copenhagen University Hospital, University of Copenhagen, Copenhagen, Denmark Respiratory Section, Hvidovre Hospital, Copenhagen University Hospital, University of Copenhagen, Copenhagen, Denmark Department of Social Medicine, Institute of Public Health, University of Copenhagen, Copenhagen, Denmark.
authors.forename: Peter
authors.initials: P
authors.lastname: Lange
authors.affiliation: Department of Clinical Pharmacology, University of Southern Denmark, Odense, Denmark.
authors.forename: Jesper
authors.initials: J
authors.lastname: Hallas
authors.affiliation: Department of Respiratory Medicine, Gentofte Hospital, Copenhagen University Hospital, University of Copenhagen, Copenhagen, Denmark Respiratory and Allergy Research Group, Manchester Academic Health Sciences Centre, University Hospital South Manchester NHS Foundation Trust, Manchester, UK.
authors.forename: Jørgen
authors.initials: J
authors.lastname: Vestbo
mesh_terms: D000368:Aged; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use*; D008297:Male; D029424:Pulmonary Disease, Chronic Obstructive / Q000188:drug therapy*; D012008:Recurrence; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors
keywords: COPD Pharmacology; COPD epidemiology; Systemic disease and lungs