title: Statins and morbidity and mortality in COPD in the COMIC study: a prospective COPD cohort study.
abstract: BACKGROUND
  Both chronic inflammation and cardiovascular comorbidity play an important role in the morbidity and mortality of patients with chronic obstructive pulmonary disease (COPD). Statins could be a potential adjunct therapy. The additional effects of statins in COPD are, however, still under discussion. The aim of this study is to further investigate the association of statin use with clinical outcomes in a well-described COPD cohort.
  
  
  METHODS
  795 patients of the Cohort of Mortality and Inflammation in COPD (COMIC) study were divided into statin users or not. Statin use was defined as having a statin for at least 90 consecutive days after inclusion. Outcome parameters were 3-year survival, based on all-cause mortality, time until first hospitalisation for an acute exacerbation of COPD (AECOPD) and time until first community-acquired pneumonia (CAP). A sensitivity analysis was performed without patients who started a statin 3 months or more after inclusion to exclude immortal time bias.
  
  
  RESULTS
  Statin use resulted in a better overall survival (corrected HR 0.70 (95% CI 0.51 to 0.96) in multivariate analysis), but in the sensitivity analysis this association disappeared. Statin use was not associated with time until first hospitalisation for an AECOPD (cHR 0.95, 95% CI 0.74 to 1.22) or time until first CAP (cHR 1.1, 95% CI 0.83 to 1.47).
  
  
  CONCLUSIONS
  In the COMIC study, statin use is not associated with a reduced risk of all-cause mortality, time until first hospitalisation for an AECOPD or time until first CAP in patients with COPD.
authors.affiliation: Department of Pulmonary Medicine, Medisch Spectrum Twente, Enschede, The Netherlands; Department of Research Methodology, Measurement, and Data analysis, University of Twente, Enschede, The Netherlands.
authors.forename: Emanuel
authors.initials: E
authors.lastname: Citgez
authors.affiliation: Medical School Twente, Medisch Spectrum Twente, Enschede, The Netherlands; Department of Research Methodology, Measurement, and Data analysis, University of Twente, Enschede, The Netherlands.
authors.forename: Job
authors.initials: J
authors.lastname: van der Palen
authors.affiliation: Department of Pulmonary Medicine , Medisch Spectrum Twente , Enschede , The Netherlands.
authors.forename: Kirsten
authors.initials: K
authors.lastname: Koehorst-Ter Huurne
authors.affiliation: Department of Clinical Pharmacy , Medisch Spectrum Twente , Enschede , The Netherlands.
authors.forename: Kris
authors.initials: K
authors.lastname: Movig
authors.affiliation: Department of Pulmonary Medicine , Medisch Spectrum Twente , Enschede , The Netherlands.
authors.forename: Paul
authors.initials: P
authors.lastname: van der Valk
authors.affiliation: Medical School Twente, Medisch Spectrum Twente , Enschede , The Netherlands.
authors.forename: Marjolein
authors.initials: M
authors.lastname: Brusse-Keizer
keywords: COPD Exacerbations; COPD Pharmacology; Pneumonia