title: Statin therapy improves survival in patients with severe pulmonary hypertension: a propensity score matching study.
abstract: Inflammation is an increasingly recognized hallmark of pulmonary hypertension (PH). Statins have been shown to attenuate key pathologic mechanisms via pleiotropic effects in animal models. However, clinical benefit of statins in patients with PH is unknown and their effect on mortality has not been studied. We performed a retrospective analysis of patients between January 2002 to January 2012, with severe PH (pulmonary artery systolic pressure ≥60 mmHg) and preserved left ventricular function (ejection fraction ≥50%), defined by transthoracic echocardiograms. Patients were divided into two groups based on statin therapy for 12 consecutive months after diagnosis of PH. Propensity score matching was performed. Subgroup analysis was done based on COPD status. Study endpoint was 1-year all-cause mortality and hospitalization. 2363 patients (age 71 ± 16; 31% male) were included; 140 (6%) were on statin therapy. Overall 1-year mortality was 34%. Following propensity score matching, 138 patients were included in the statin group and 624 patients in the no-statin group; all-cause mortality was significantly lower in the statin group compared with the no-statin group [15.2 vs. 33.8%, HR 0.42 (95% CI 0.27, 0.66), p < 0.001], but hospitalization was comparable between two groups. After stratifying patients based on COPD status, patients with COPD showed a marginally significant survival benefit from statins [HR 0.53 (95% CI 0.26, 1.10), p = 0.09]; and statins significantly reduced 1-year all-cause mortality in patients without COPD [HR 0.36 (95% CI 0.19, 0.67), p = 0.001]. We found no significant difference in the effect of statins on patients with COPD compared to those without (p = 0.16). Statin therapy is associated with reduced mortality risk in patients with severe PH and preserved left ventricular function. This beneficial effect was not found to be dependent on COPD status. These novel findings should be confirmed in large randomized trials.
authors.affiliation: Department of Medicine, Jacobi Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA.
authors.forename: Luise
authors.initials: L
authors.lastname: Holzhauser
authors.affiliation: Department of Medicine, Jacobi Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA.
authors.forename: Ninel
authors.initials: N
authors.lastname: Hovnanians
authors.affiliation: Department of Medicine, Jacobi Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA.
authors.forename: Parham
authors.identifier: http://orcid.org/0000-0001-8134-1787
authors.initials: P
authors.lastname: Eshtehardi
authors.affiliation: Department of Medicine, Jacobi Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA.
authors.forename: M Khalid
authors.initials: MK
authors.lastname: Mojadidi
authors.affiliation: Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, GA, USA.
authors.forename: Yi
authors.initials: Y
authors.lastname: Deng
authors.affiliation: Department of Medicine, Jacobi Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA.
authors.forename: David
authors.initials: D
authors.lastname: Goodman-Meza
authors.affiliation: Department of Medicine, Jacobi Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA.
authors.forename: Pavlos
authors.initials: P
authors.lastname: Msaouel
authors.affiliation: Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, GA, USA.
authors.forename: Yi-An
authors.initials: YA
authors.lastname: Ko
authors.affiliation: Division of Cardiology, Department of Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA. ronald.zolty@unmc.edu.|Right-Sided Heart Failure Program, University of Nebraska Medical Center, 982265 Nebraska Medical Center, Omaha, NE, 68198, USA. ronald.zolty@unmc.edu.
authors.forename: Ronald
authors.initials: R
authors.lastname: Zolty
mesh_terms: D000368:Aged; D002423:Cause of Death / Q000639:trends; D015150:Echocardiography, Doppler; D005260:Female; D006352:Heart Ventricles / Q000000981:diagnostic imaging / Q000187:drug effects / Q000503:physiopathology*; D006760:Hospitalization / Q000639:trends; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use*; D006976:Hypertension, Pulmonary / Q000188:drug therapy* / Q000401:mortality / Q000503:physiopathology; D008297:Male; D009519:New York City / Q000453:epidemiology; D057216:Propensity Score; D011669:Pulmonary Wedge Pressure / Q000502:physiology*; D012189:Retrospective Studies; D012720:Severity of Illness Index; D015996:Survival Rate / Q000639:trends; D016277:Ventricular Function, Left / Q000187:drug effects / Q000502:physiology*
chemical_list: D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors
keywords: Mortality; Pulmonary hypertension; Statin