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Statin therapy improves survival in patients with severe pulmonary hypertension: a propensity score matching study

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Abstract

Inflammation is an increasingly recognized hallmark of pulmonary hypertension (PH). Statins have been shown to attenuate key pathologic mechanisms via pleiotropic effects in animal models. However, clinical benefit of statins in patients with PH is unknown and their effect on mortality has not been studied. We performed a retrospective analysis of patients between January 2002 to January 2012, with severe PH (pulmonary artery systolic pressure ≥60 mmHg) and preserved left ventricular function (ejection fraction ≥50%), defined by transthoracic echocardiograms. Patients were divided into two groups based on statin therapy for 12 consecutive months after diagnosis of PH. Propensity score matching was performed. Subgroup analysis was done based on COPD status. Study endpoint was 1-year all-cause mortality and hospitalization. 2363 patients (age 71 ± 16; 31% male) were included; 140 (6%) were on statin therapy. Overall 1-year mortality was 34%. Following propensity score matching, 138 patients were included in the statin group and 624 patients in the no-statin group; all-cause mortality was significantly lower in the statin group compared with the no-statin group [15.2 vs. 33.8%, HR 0.42 (95% CI 0.27, 0.66), p < 0.001], but hospitalization was comparable between two groups. After stratifying patients based on COPD status, patients with COPD showed a marginally significant survival benefit from statins [HR 0.53 (95% CI 0.26, 1.10), p = 0.09]; and statins significantly reduced 1-year all-cause mortality in patients without COPD [HR 0.36 (95% CI 0.19, 0.67), p = 0.001]. We found no significant difference in the effect of statins on patients with COPD compared to those without (p = 0.16). Statin therapy is associated with reduced mortality risk in patients with severe PH and preserved left ventricular function. This beneficial effect was not found to be dependent on COPD status. These novel findings should be confirmed in large randomized trials.

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Abbreviations

BNP:

Brain-natriuretic peptide

COPD:

Chronic obstructive pulmonary disease

LVEF:

Left ventricular ejection fraction

PAP:

Pulmonary artery pressure

PASP:

Pulmonary artery systolic pressure

PH:

Pulmonary hypertension

RV:

Right ventricle

RVSP:

Right ventricular systolic pressure

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    Authors and Affiliations

    1. Department of Medicine, Jacobi Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA

      Luise Holzhauser, Ninel Hovnanians, Parham Eshtehardi, M. Khalid Mojadidi, David Goodman-Meza & Pavlos Msaouel

    2. Division of Cardiology, Department of Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA

      Ronald Zolty

    3. Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, GA, USA

      Yi Deng & Yi-An Ko

    4. Right-Sided Heart Failure Program, University of Nebraska Medical Center, 982265 Nebraska Medical Center, Omaha, NE, 68198, USA

      Ronald Zolty

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    1. Luise Holzhauser
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    L. Holzhauser, N. Hovnanians, and P. Eshtehardi contributed equally to this manuscript.

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    Holzhauser, L., Hovnanians, N., Eshtehardi, P. et al. Statin therapy improves survival in patients with severe pulmonary hypertension: a propensity score matching study. Heart Vessels 32, 969–976 (2017). https://doi.org/10.1007/s00380-017-0957-8

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