The Use of Statins in Respiratory Diseases

Abstract

Statin drugs inhibit 3-hydroxy-3-methylglutaryl coenzyme A reductase, the rate limiting step in cholesterol synthesis, and are used primarily to lower cholesterol levels, in particular that of low-density lipoprotein cholesterol. Several studies have confirmed that as a result of their effects the statins reduce or prevent heart disease and stroke in patients with and without a history of cardiovascular disease. However, beyond their cardiovascular benefits, statins seem to have a number of beneficial effects in patients with respiratory disorders including asthma, community-acquired pneumonia, chronic obstructive pulmonary disease, lung cancer, pulmonary hypertension, and interstitial lung disease, among several others. There is considerable debate as to the mechanisms underlying these potential benefits, with some suggesting that they may represent nothing more than a "healthy user" effect. The latter describes that fact that although statin users are often older, and have underlying comorbid conditions, they may also potentially be patients more concerned with their health and more likely to give up smoking, take regular exercise, eat healthy diets, and have regular influenza and pneumococcal vaccination. However, statins have been shown to have a number of additional anti-inflammatory, immunomodulatory effects (so-called pleiotropic effects) that could underlie these potential benefits. Thus, although many studies have documented the potential benefit of statin use in the prevention and/or treatment of various respiratory conditions, a number of investigators consider that definitive proof of their benefit requires the undertaking of prospective, randomized, controlled studies. © 2009 by Lippincott Williams & Wilkins.