Statins in COPD: Selection Modalities and Mortalities



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Cardiovascular disease contributes a significant share in the all-cause mortality of COPD, and therefore it is sensible to assume similar positive outcomes with its mortality benefiting measures in the COPD group as well. Raymakers et al. study published in CHEST (September 2017) portrayed a significant all-cause and COPD related mortality benefits with statins. The inclusion of a vast number of participants from databases with a follow-up for a reasonable duration and a focus on adherence towards statins are the strengths of this retrospective study. Though the results endorsed a clear benefit with statins, the rationale for certain selection methods and their potential bias cannot be overlooked. In contrary to the authors’ quotation on the frequent existence of COPD among the population older than 30 years of age, they have only included individuals aged 50 years and above. A population with a mean age of 70 years might have integrated a high prevalence of known or subclinical cardiovascular disease. Remarkably, documentation of this morbidity’s existence in the studied COPD population was not attempted. It could have been more interesting to observe the statin-related mortality benefit among the subgroup of COPDs without having a known cardiovascular disease. Most importantly, identifying COPD patients based on anticholinergic or beta agonist use without spirometry confirmation might have allowed diagnostic inaccuracies and also unexploited the significance of disease severity. Occurrence of such misdiagnosis without the support of spirometry was recognized by few studies earlier and for that reason the evidence based guidelines strongly recommended the objective measurement of airflow limitation for confirmation.


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