Efficacy and Safety of Statins for Pulmonary Hypertension: A Meta-Analysis of Randomised Controlled Trials.

BACKGROUND: Pulmonary hypertension (PH) is a serious disease, and treatment is a continuing challenge. Some in vitro and in vivo studies identified that statins were effective for PH. However, results of some randomised controlled trials (RCTs) have been controversial. The objective of our study was to clarify whether statins are effective and safe for pulmonary hypertension. METHODS: We systematically searched for eligible RCTs from PubMed, EMBASE, Web of Science, and the Cochrane Library during January 2016. Two reviewers independently extracted data. Standard mean differences (SMDs) and weighted mean differences (WMDs) with 95% confidence intervals (CIs) were estimated for continuous data (exercise capacity cardiac, pulmonary arterial pressure (PAP), cardiac index, and low-density lipoprotein (LDL)). Risk ratios (RRs) were estimated for dichotomous data (adverse events and clinical deterioration). RESULTS: A total of 496 patients from six RCTs were included. Low-density lipoprotein in the statin group decreased significantly compared with the placebo group (WMD = -22.79; 95% CI: -34.33 ∼ -11.24). However, we did not find a statistically significant effect on exercise capacity (SMD = 0.18; 95% CI: -0.34 - 0.71), PAP (WMD = -3.01; 95% CI: -8.68 - 2.65), or CI (WMD = -0.04; 95% CI: -0.15 - 0.23). Additionally, there was no difference between statins and placebo with respect to hepatic injury (RR: 1.12; 95% CI: 0.43 - 2.92), myalgia (RR: 0.81; 95% CI: 0.32 - 2.03), or clinical deterioration (RR: 0.98; 95% CI: 0.58 - 1.67). CONCLUSIONS: Statin treatment appears to be safe but may have no effect on PH.

The Effects and Mechanism of Atorvastatin on Pulmonary Hypertension Due to Left Heart Disease.

BACKGROUND: Pulmonary hypertension due to left heart disease (PH-LHD) is one of the most common forms of PH, termed group 2 PH. Atorvastatin exerts beneficial effects on the structural remodeling of the lung in ischemic heart failure. However, few studies have investigated the effects of atorvastatin on PH due to left heart failure induced by overload. METHODS: Group 2 PH was induced in animals by aortic banding. Rats (n = 20) were randomly divided into four groups: a control group (C), an aortic banding group (AOB63), an atorvastatin prevention group (AOB63/ATOR63) and an atorvastatin reversal group (AOB63/ATOR50-63). Atorvastatin was administered for 63 days after banding to the rats in the AOB63/ATOR63 group and from days 50 to 63 to the rats in the AOB63/ATOR50-63 group. RESULTS: Compared with the controls, significant increases in the mean pulmonary arterial pressure, pulmonary arteriolar medial thickening, biventricular cardiac hypertrophy, wet and dry weights of the right middle lung, percentage of PCNA-positive vascular smooth muscle cells, inflammatory infiltration and expression of RhoA and Rho-kinase II were observed in the AOB63 group, and these changes concomitant with significant decreases in the percentage of TUNEL-positive vascular smooth muscle cells. Treatment of the rats in the AOB63/ATOR63 group with atorvastatin at a dose of 10 mg/kg/day significantly decreased the mean pulmonary arterial pressure, right ventricular hypertrophy, pulmonary arteriolar medial thickness, inflammatory infiltration, percentage of PCNA-positive cells and pulmonary expression of RhoA and Rho-kinase II and significantly augmented the percentage of TUNEL-positive cells compared with the AOB63 group. However, only a trend of improvement in pulmonary vascular remodeling was detected in the AOB63/ATOR50-63 group. CONCLUSIONS: Atorvastatin prevents pulmonary vascular remodeling in the PH-LHD model by down-regulating the expression of RhoA/Rho kinase, by inhibiting the proliferation and increasing the apoptosis of pulmonary arterial smooth muscle cells, and by attenuating the inflammation of pulmonary arteries.