MD Conference Express ATS 2013 - (Page 15)
al. recently published a summary explaining the conflicting
results [Thorax 2012]. The duration of CPAP, patient age,
comorbidities, and the severity of OSA and intermittent
hypoxia all appear to be critical factors in the relative success
of CPAP in treating OSA.
Statin Use Improves RespiratoryRelated Mortality in Patients
With COPD
Written by Phil Vinall
There is mounting evidence for an association between
statin use and reduced all-cause mortality among
patients with chronic obstructive pulmonary disease
[Lahousse L et al. Pulm Pharmacol Ther 2013; Young RP
et al. Eur Respir Rev 2009; Janda S et al. Chest 2009; Young
RP et al. Postgrad Med J 2009]. Robert P. Young, MD,
PhD, University of Auckland, Auckland, New Zealand,
presented results from an observational study indicating
that this benefit is of particular significance in terms of
respiratory-related mortality.
Prof. Young reported the results of a subanalysis
of the data from a recent study, which reported a 30%
reduction (HR, 0.69; 95% CI, 0.58 to 0.84; p<0.01) in allcause mortality after 4 years of follow-up in COPD patients
taking statins [Lawes CM et al. Prim Care Respir J 2012].
The study comprised 1687 patients (596 statin users; 1091
nonusers; mean age 70.6 years) who were admitted to
any New Zealand public hospital during 2006 and had
a discharge diagnosis of first episode of COPD. Cases of
COPD were identified through national hospital codes.
Medication usage was based on a national drug-dispensing
database and outcomes for those patients taking statins
were compared with patients not taking statins, adjusted
for confounding using a propensity score approach.
Cause of death was ascertained through death certificate
documentation up to the end of 2012 and sub-grouped
(respiratory, cardiovascular, and other deaths).
Statin users were significantly more likely to be men
(58.4%) and to have a history of cardiovascular disease
(58.6%) compared with non-statin users (48.5% and 25.1%,
respectively; both p<0.001). Significantly more statin users
were taking furosemide (which was used as a proxy for heart
failure; 47.7% vs 24.5%) and significantly more had been
diagnosed with diabetes (35.4% vs 11.6%; both p<0.001)
than statin non-users. The proportion of deaths was similar
between the two groups: 242 deaths (40.6%) in the statin
group versus 429 deaths (39.3%) among those non-statin
users. After adjustment for age, sex, ethnic group, history
of cardiovascular disease, diabetes, and prescription for
furosemide, the hazard ratio for statin users versus statin
non-users for all-cause mortality was 0.69 (95% CI, 0.58 to
0.84; p<0.01).
For their follow-up analysis, Prof. Young and colleagues
obtained the specific cause of death for those who died
during the follow-up period of 6 years in the Lawes study
[Lawes CM et al. Prim Care Respir J 2012]. A significant
reduction was noted in respiratory death (chest infection,
COPD exacerbation, pneumonia, respiratory failure)
and “other deaths” with adjusted HRs of 0.55 and 0.55
respectively (95% CI, 0.43 to 0.78 and 0.35 to 0.85; p=0.0009
and p=0.008, respectively). Within the “other deaths”
category there was a significant reduction in cancer deaths
but no reduction in cardiovascular death.
The investigators concluded that statin therapy
confers a benefit on mortality in COPD for respiratory
complications leading to death. They noted that although
two randomized studies of statin use in patients with
COPD have shown significant improvement in exercise
tolerance and quality of life [Lee T-M et al. Am J Cardiol
2008; McDonald VM et al. Thorax 2013] a reduction in
mortality is even more important. The results of this
study support the hypothesis that the systemic immunemodulatory effects of statins are beneficial in COPD and
suggest a need for a randomized controlled trial to assess
the role of adjunct statin therapy in reducing systemic
and pulmonary inflammation in patients with COPD.
Addition of Spironolactone to
Ambrisentan May Be a Novel
Treatment Strategy to Improve
Outcome in Patients With PAH
Written by Maria Vinall
Bradley Maron, MD, Brigham and Women’s Hospital,
Harvard Medical School, Boston, Massachusetts,
USA, presented the results of a retrospective study
that demonstrated a trend toward additional clinical
improvement when spironolactone was added to
ambrisentan for the treatment of patients with pulmonary
arterial hypertension (PAH).
In patients with PAH, levels of the mineralocorticoid
hormone aldosterone are increased in the pulmonary
arterial circulation and correlate positively with
hemodynamic measures of pulmonary vascular remodeling
[Maron BA et al. Eur J Heart Fail 2013]. In addition,
results from recent basic and translational models of PAH
suggest that hyperaldosteronism modulates a pulmonary
vasculopathy by promoting endothelin receptor
type-B (ETB) dysfunction in pulmonary endothelial
cells [Maron BA et al. Circulation 2012; Maron BA et al.
Am J Cardiol 2013. In press], which is required for
Official Peer-Reviewed Highlights From the American Thoracic Society International Conference 2013
15
Table of Contents for the Digital Edition of MD Conference Express ATS 2013
MD Conference Express ATS 2013
Contents
Prevention and Early Treatment of Acute Lung Injury
Nocturnal Noninvasive Ventilation Improves Outcomes in Multiple Disorders
Hospital Readmissions: Challenges and Opportunities
EBUS-TBNA: Accurate and Safe for Detecting Sarcoidosis
Data Link Obstructive Sleep Apnea and Type 2 Diabetes
Statin Use Improves Respiratory-Related Mortality in Patients With COPD
Addition of Spironolactone to Ambrisentan May Be a Novel Treatment Strategy to Improve Outcome in Patients With PAH
Haloperidol Does Not Prevent Delirium in Ventilated ICU Patients
Beraprost Plus Sildenafil Effective in Pulmonary Arterial Hypertension
Dupilumab Is Safe and Effective for Controlling Asthma Attacks
Once-Daily QVA149 Improves Breathlessness in COPD Patients
CPAP in CVD and OSA Does Not Significantly Improve Cardiovascular Biomarkers
CPAP Reduces BP in Patients With Resistant Hypertension and Obstructive Sleep Apnea
Effects of Obesity on COPD
Pulmonary Embolism
Ventilator-Associated Pneumonia
Lung Cancer Screening
Idiopathic Pulmonary Fibrosis
Non-Small-Cell Lung Cancer
MD Conference Express ATS 2013
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