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. 2019 Dec;7(23):786.
doi: 10.21037/atm.2019.11.19.

Efficacy and safety of statin therapy in pulmonary hypertension: a systematic review and meta-analysis

Fangying Chen  1   2 , Mei Yang  1 , Chun Wan  1 , Lin Liu  3 , Lei Chen  1
Affiliations

Efficacy and safety of statin therapy in pulmonary hypertension: a systematic review and meta-analysis

Fangying Chen et al. Ann Transl Med. 2019 Dec.

Abstract

Background: 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.

Methods: 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.

Results: 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).

Conclusions: 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.

Keywords: Pulmonary hypertension (PH); chronic obstructive pulmonary disease (COPD); meta-analysis; pulmonary arterial hypertension (PAH); statins.

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Conflict of interest statement

Conflicts of Interest: The authors declare they have no conflict of interests.

Figures

Figure 1
Figure 1
PRISMA flowchart outlining the literature search process.
Figure 2
Figure 2
Risk of bias graph.
Figure 3
Figure 3
Summary effects of statins in PH. PAP, pulmonary arterial pressure; WMD, weighted mean difference; CI, confidence interval; 6MWD, 6-minute walking distance; CDI, cardiac index; LDL, low-density lipoprotein; SMD, standardized mean difference; RR, risk ratio; PH, pulmonary hypertension.
Figure 4
Figure 4
Summary effects of statins on PAP (A,B) and 6-minute walk distance (C,D) in COPD (A,C) and PAH (B,D). PAP, pulmonary arterial pressure; WMD, weighted mean difference; CI, confidence interval; 6MWD, 6-minute walking distance; PAH, pulmonary arterial hypertension; COPD, chronic obstructive pulmonary disease.
Figure 5
Figure 5
The leave-one-out sensitivity analysis for the effect of statins on PAP in PH patients. CI, confidence interval; PAP, pulmonary arterial pressure; PH, pulmonary hypertension.
See this image and copyright information in PMC

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