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Chronic obstructive pulmonary disease (COPD) is a progressive condition that if uncontrolled will lead to multiple exacerbations and frequent hospitalizations. In 2010, COPD was ranked in the United States as the third leading cause of death.1 The economic burden to manage COPD is also costly. It was estimated in 2008 that a total of 68 billion dollars were used in health care expenditures for COPD and asthma management.2 The current pharmacologic therapies used for COPD decrease symptoms, decrease frequency of exacerbations, and improve quality of life.3 Limited observational studies have reported the benefit of statins in COPD patients unrelated to their lipid lowering properties and proposed due to their anti-inflammatory effects.4,5,6 Mancini et al.4 retrospectively evaluated COPD patients on an ACEI, ARB, statin, or the combination of a statin with either an ACEI or ARB for the effect on the rate of hospitalization for COPD compared to no therapy. There was a significant reduction in COPD hospitalization for both the statin monotherapy group (RR 0.72; p = 0.0091) and combination statin/ACEI or ARB group (RR 0.66; p = 0.0012). Alexeeff et al.5 reported that the annual rate of decline of forced expiratory volume in 1 second (FEV1)was significantly less in elderly patients treated with statins compared to patients not on statin therapy, 10.9 mL vs. 23.9 mL, respectively (p<0.001).

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The Prospective Randomized Placebo-Controlled Trial of Simvastatin in the Prevention of COPD Exacerbations (STATCOPE) compared simvastatin 40 mg daily to placebo for 12 to 36 months.6 Patients included were between 40-80 years of age, current or former smoker (10 or more pack-years), had moderate to severe COPD defined by the Global Initiative for Chronic Obstructive Lung Disease (GOLD) criteria.3 In addition, the patient met at least one of the following within a year prior to enrollment: required supplemental oxygen, prescribed systemic glucocorticoids or antibiotic agents for respiratory issues, or had an emergency department visit or hospital admission for a COPD exacerbation. Key exclusion criteria included patients already on a statin, patients eligible for statin therapy per the Adult Treatment Panel III guidelines, those on medications contraindicated with statin use, those who could not tolerate statins, and individuals with active liver disease. The primary outcome was the annual exacerbation rate. Exacerbation was defined as worsening or new presentation of at least two respiratory symptoms (i.e., cough, sputum, wheezing, dyspnea, or chest tightness) for a minimum of 3 days and treated with systemic glucocorticoids or antibiotics. The secondary outcomes evaluated were the severity of exacerbations, changes in spirometric measures, the number of acute cardiovascular events, and the time to initial exacerbation.6

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Overall, 430 patients received simvastatin compared to 447 patients in the control arm and were followed for about 640 days. Baseline characteristics were similar between groups with a mean age of 62.2+8.4 years, mean FEV1 of 41.6+17.7% of the predicted value, mean smoking history of approximately 50 pack-years, and 50% ...

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