Chen Fangying, Yang Mei, Wan Chun, Liu Lin, Chen Lei
Department of Respiratory and Critical Care Medicine, West China Hospital, West China School of Medicine, Sichuan University, Chengdu 610041, China.
Department of Tuberculosis, the Third People's Hospital of Tibet Autonomous Region, Lhasa 850000, China.
Ann Transl Med. 2019 Dec;7(23):786. doi: 10.21037/atm.2019.11.19.
Pulmonary hypertension (PH) is a multi-causal disease and no satisfactory therapeutic strategies for it. Statins have been suggested as potential drugs in PH, whose effects in different clinic types of PH have not been conclusive. In this study, we included randomized controlled clinical trials (RCTs) evaluating the efficacy and safety of statins therapy in PH.
We searched databases including Medline, Embase, Cochrane, PubMed and Web of science, with time up to January 1, 2019. With 95% confidence interval (CI), weighted mean difference (WMD) or standardized mean difference (SMD) was pooled and calculated in a random or fixed effect model according to I2 statistic.
A total of nine RCTs with 657 patients were included. Four types of statins (atorvastatin, pravastatin, rosuvastatin and simvastatin) were used at different doses (10-80 mg daily) for up to 6 months. In the pooled-data analysis, compared with placebo, there were significant improvements in pulmonary arterial pressure (PAP), in addition to low-density lipoprotein (LDL) in patients treated with statins, but not in 6-minute walking distance (6MWD), cardiac index (CDI). No more adverse events and all-cause mortality were revealed. Subgroup analysis indicated that statins could decrease PAP in the subtype of PH due to chronic obstructive pulmonary disease (COPD), but not pulmonary arterial hypertension (PAH).
This study indicates that statins can efficiently and safely reduce PAP in PH, especially in the subtype due to COPD. Further RCTs are needed to focus on the efficacy and safety of statin therapy in different subtypes of PH.
肺动脉高压（PH）是一种多病因疾病，目前尚无令人满意的治疗策略。他汀类药物被认为是治疗PH的潜在药物，但其在不同临床类型PH中的作用尚无定论。在本研究中，我们纳入了评估他汀类药物治疗PH疗效和安全性的随机对照临床试验（RCT）。
我们检索了包括Medline、Embase、Cochrane、PubMed和Web of science在内的数据库，检索时间截至2019年1月1日。采用95%置信区间（CI），根据I2统计量，在随机或固定效应模型中合并并计算加权平均差（WMD）或标准化平均差（SMD）。
共纳入9项RCT，657例患者。使用了四种他汀类药物（阿托伐他汀、普伐他汀、瑞舒伐他汀和辛伐他汀），不同剂量（每日10 - 80毫克），治疗时间长达6个月。在汇总数据分析中，与安慰剂相比，他汀类药物治疗的患者肺动脉压（PAP）以及低密度脂蛋白（LDL）有显著改善，但6分钟步行距离（6MWD）、心脏指数（CDI）无改善。未发现更多不良事件和全因死亡率。亚组分析表明，他汀类药物可降低慢性阻塞性肺疾病（COPD）所致PH亚型的PAP，但对肺动脉高压（PAH）无效。
本研究表明，他汀类药物可有效、安全地降低PH患者的PAP，尤其是COPD所致亚型。需要进一步的RCT来关注他汀类药物治疗不同亚型PH的疗效和安全性。
