Zhang Ming-Zhou, Qian De-Hui, Xu Jian-Cheng, Yao Wei, Fan Ye, Wang Chang-Zheng
Department of Respiratory Disease, Chongqing Xinqiao Hospital, Third Military Medical University, Chongqing 40037, China.
Department of Cardiology, Chongqing Xinqiao Hospital, Third Military Medical University, Chongqing 40037, China.
J Thorac Dis. 2017 Aug;9(8):2437-2446. doi: 10.21037/jtd.2017.07.06.
Previous animal studies and clinical trials report inconsistent findings regarding the role of statins in pulmonary hypertension (PH). Systematic reviews have shown no use of statins on pulmonary arterial hypertension (PAH). This is the first meta-analysis of randomized controlled trials (RCTs) determining the clinical impacts of statin therapy on patients with PH secondary to lung diseases.
Electronic databases and manual bibliographical searches were conducted. Eligible studies included RCTs of at least 3 months that evaluated statin therapy as compared with control in adult patients with PH due to pulmonary diseases. Statistical analyses were performed to calculate mean difference, relative risks (RRs), and 95% confidence intervals (CIs) using random-effect model.
A total of 6 RCTs were identified and included in this study. Five trials reported the effects of statins in patients with both chronic obstructive pulmonary disease (COPD) and PH, and the remaining 1 was based on PH due to pneumoconiosis. We found that statin therapy was associated with increased 6-minute walk distance and reduced pulmonary artery systolic pressure. There was no observed difference in the incidence of death, drug withdrawal, and adverse event between statin and control group.
Our findings suggest that statins might be safe and beneficial for patients with PH due to chronic lung diseases. However, larger RCTs with more patients and longer observational duration are needed.
先前的动物研究和临床试验关于他汀类药物在肺动脉高压(PH)中的作用报告了不一致的结果。系统评价表明未将他汀类药物用于肺动脉高压(PAH)。这是第一项对随机对照试验(RCT)进行的荟萃分析,以确定他汀类药物治疗对肺部疾病继发的PH患者的临床影响。
进行了电子数据库检索和手动文献检索。符合条件的研究包括至少3个月的RCT,这些试验评估了他汀类药物治疗与因肺部疾病导致的成年PH患者对照组的疗效。使用随机效应模型进行统计分析以计算平均差、相对风险(RRs)和95%置信区间(CIs)。
共确定并纳入了6项RCT。5项试验报告了他汀类药物对慢性阻塞性肺疾病(COPD)合并PH患者的影响,其余1项基于尘肺病所致的PH。我们发现他汀类药物治疗与6分钟步行距离增加和肺动脉收缩压降低有关。他汀类药物组和对照组在死亡、停药和不良事件发生率方面未观察到差异。
我们的研究结果表明,他汀类药物可能对慢性肺部疾病所致的PH患者安全且有益。然而,需要更多患者参与且观察期更长的大型RCT。