Abstract
Since the evidence regarding statin therapy in PAH has not been conclusive, we assessed the impact of statin therapy in PAH through a systematic review and meta-analysis of available studies. We searched selected databases up to August 1, 2015 to identify the studies investigating the effect of statin administration on PAH. Meta-analysis was performed using either a fixed-effects or random-effect model according to I2 statistic. Meta-analysis of 8 studies with 665 patients did not suggest any significant improvement in 6-min walking distance (6MWD) by statin therapy (weighed mean difference [WMD]: −6.08 m, 95% confidence interval [CI]: −25.66, 13.50, p = 0.543; Q = 8.41, I2 = 28.64%). Likewise, none of the other indices including pulmonary arterial pressure (WMD: −0.97 mmHg, 95%CI: −4.39, 2.44, p = 0.577; Q = 14.64, I2 = 79.51%), right atrial pressure (WMD: 1.01 mmHg, 95%CI: −0.93, 2.96, p = 0.307; Q = 44.88, I2 = 95.54%), cardiac index (WMD: 0.05 L/min/m2, 95%CI: −0.05, 0.15, p = 0.323; Q = 3.82, I2 = 21.42%), and pulmonary vascular resistance (WMD: −1.42 dyn*s/cm5, 95%CI: −72.11, 69.27, p = 0.969; Q = 0.69, I2 = 0%) was significantly altered by statin therapy. In conclusion, the results of the meta-analysis did not show a statistically significant effect of statin therapy in the improvement of 6MWD, pulmonary arterial pressure, right atrial pressure, cardiac index and pulmonary vascular resistance.
Highlights
Pulmonary hypertension (PAH) is defined according to the new 2015 Guidelines of the European Society of Cardiology (ESC) and European Respiratory Society (ERS) as an increase of the mean pulmonary arterial pressure (PAPm) above 25 mmHg at rest, assessed by right heart catheterization (RHC) and pulmonary vascular resistance (PVR) above 3 Wood units[1]
Out of 16 eligible papers, 6 were excluded since they were not conducted in subjects with PAH, one of them did not assess any of the pre-specified efficacy measures, and one was not a clinical study
Other experimental studies on murine models reported an inhibition of progression of emphysema and pulmonary hypertension related to tobacco exposure after statin therapy[41,42]
Summary
Pulmonary hypertension (PAH) is defined according to the new 2015 Guidelines of the European Society of Cardiology (ESC) and European Respiratory Society (ERS) as an increase of the mean pulmonary arterial pressure (PAPm) above 25 mmHg at rest, assessed by right heart catheterization (RHC) and pulmonary vascular resistance (PVR) above 3 Wood units[1]. Hypertension due to left heart disease, pulmonary hypertension due to lung diseases and/or hypoxia, chronic thromboembolic pulmonary hypertension and other pulmonary artery obstructions, and pulmonary hypertension with unclear and/or multifactorial mechanisms[1]. Several prognostic factors such as right ventricular failure, higher World Health Organization functional classification (WHO FC), shorter 6-min walk distance (6MWD) and hemodynamic factors such as right atrial pressure, and brain natriuretic peptide (BNP) levels are useful for PAH prognosis[2,3]. Since statins have been suggested as potential drugs for PAH treatment[10], we assessed the impact of statin therapy on multiple parameters in PAH in this systematic review and meta-analysis
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