Master Program in Clinical Pharmacy, School of Pharmacy, Kaohsiung Medical University, Kaohsiung, Taiwan.
Department of Pharmacy, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan.
Sci Rep. 2020 Feb 20;10(1):3104. doi: 10.1038/s41598-020-59828-0.
In Taiwan, patients with pulmonary hypertension (PH) related to chronic obstructive pulmonary disease (COPD) are most common PH population (group 3). However, efficacy of medical treatments and optimal prevention methods in this group remain uncertain. Statins such as indirect RhoA/Rho-kinase inhibitors influence one of key signalling pathways that promote PH onset. In this study, we explored protective effects of statins against PH in COPD patients using database from Taiwan National Health Insurance programme from 2002 to 2017. The main outcome was the risk of PH. The Cox proportional-hazards model and the Fine and Gray model were used to adjust covariate and competing risks to estimate the subdistribution hazard ratios (sHRs). 553,617 newly diagnosed COPD patients were stratified by statin users (n = 41,168) and statin nonusers (n = 512,449). After 1:1 propensity score matching of statin users (n = 41,163), and 41,163 statin nonusers were included for outcome analysis. Statin users had a 22% lower risk of PH than nonusers (sHR: 0.78, 95% confidence interval: 0.65-0.94). During subgroup analysis, taking higher daily doses and for a longer duration displayed a more significantly reduced risk of PH (both P for trend <0.001). Statins may have a protective effect against PH that is dose- and time-dependent.
在台湾，与慢性阻塞性肺疾病（COPD）相关的肺动脉高压（PH）患者是最常见的 PH 人群（第 3 组）。然而，该人群的医学治疗效果和最佳预防方法仍不确定。他汀类药物等间接 RhoA/Rho-激酶抑制剂影响促进 PH 发病的关键信号通路之一。在这项研究中，我们使用了来自 2002 年至 2017 年台湾全民健康保险计划的数据库，探讨了他汀类药物对 COPD 患者 PH 的保护作用。主要结局是 PH 的风险。Cox 比例风险模型和 Fine 和 Gray 模型用于调整协变量和竞争风险，以估计亚分布风险比（sHR）。根据他汀类药物使用者（n=41168）和他汀类药物非使用者（n=512449）将 553617 例新诊断的 COPD 患者分层。在 1:1 倾向评分匹配他汀类药物使用者（n=41163）后，将 41163 例他汀类药物非使用者纳入结局分析。他汀类药物使用者发生 PH 的风险比非使用者低 22%（sHR：0.78，95%置信区间：0.65-0.94）。在亚组分析中，较高的每日剂量和较长的用药时间显示出更显著降低 PH 的风险（趋势 P 值均<0.001）。他汀类药物可能对 PH 具有保护作用，且呈剂量和时间依赖性。
