Key result
Simvastatin fails to improve aortic pulse wave velocity vs placebo in stable COPD patients.
Why the study?
There is excess cardiovascular mortality in patients with COPD, with increased aortic stiffness and inflammation, and statins may modulate these factors.
Does simvastatin 20 mg once daily reduce aortic stiffness and systemic and airway inflammation in stable patients with chronic obstructive pulmonary disease?
RCT (n=70)
Double-blind
randomized
Does simvastatin 20 mg once daily reduce aortic stiffness and systemic and airway inflammation in stable patients with chronic obstructive pulmonary disease?
Mean Difference: -0.7
p-value: p=0.24
Simvastatin 20 mg daily for 6 weeks did not significantly reduce aortic stiffness in all COPD patients, but improved it in those with high baseline stiffness.
Simvastatin did not reduce aortic stiffness overall in COPD; leaves open possible benefit in high-baseline-stiffness subgroup for targeted trials.
BACKGROUND: There is excess cardiovascular mortality in patients with chronic obstructive pulmonary disease. Aortic stiffness, an independent predictor of cardiovascular risk, and systemic and airway inflammation are increased in patients with the disease. Statins modulate aortic stiffness and have anti-inflammatory properties. A proof-of-principle, double-blind, randomized trial determined if 6 weeks of simvastatin 20 mg once daily reduced aortic stiffness and systemic and airway inflammation in patients with chronic obstructive pulmonary disease. METHODS: Stable patients (n=70) were randomized to simvastatin (active) or placebo. Pre-treatment and post-treatment aortic stiffness, blood pressure, spirometry, and circulating and airway inflammatory mediators and lipids were measured. A predefined subgroup analysis was performed where baseline aortic pulse wave velocity (PWV) was >10 m/sec. RESULTS: Total cholesterol dropped in the active group. There was no significant change in aortic PWV between the active group and the placebo group (-0.7 m/sec, P=0.24). In those with aortic stiffness >10 m/sec (n=22), aortic PWV improved in the active group compared with the placebo group (-2.8 m/sec, P=0.03). Neither systemic nor airway inflammatory markers changed. CONCLUSION: There was a nonsignificant improvement in aortic PWV in those taking simvastatin 20 mg compared with placebo, but in those with higher baseline aortic stiffness (a higher risk group) a significant and clinically relevant reduction in PWV was shown.
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John et al. (2015) conducted an RCT in chronic obstructive pulmonary disease (n=70). simvastatin vs. placebo was evaluated on change in aortic pulse wave velocity (MD -0.7 m/sec, p=0.24). Simvastatin 20 mg daily for 6 weeks did not significantly improve aortic pulse wave velocity compared with placebo in stable COPD patients (difference -0.7 m/sec, P=0.24).
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