SYSTEMATIC REVIEW article
Front. Med.
Sec. Pulmonary Medicine
Volume 12 - 2025 | doi: 10.3389/fmed.2025.1640270
Comparative effectiveness of Statins for Chronic Obstructive Pulmonary Disease Patients with Pulmonary Hypertension: systematic review and network meta-analysis
Provisionally accepted
- 1Guangzhou University of Traditional Chinese Medicine Shenzhen Hospital, Shenzhen, China
- 2Shenzhen Traditional Chinese Medicine Hospital, Shenzhen, China
- 3Department of Endocrinology, Shenzhen Hospital of Guangzhou University of Chinese Medicine, Shenzhen, China
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Introduction and objectives: Statins may effectively treat PH-COPD, but current guidelines do not endorse their use. This study aims to assess the comparative effectiveness and safety of Statins in adult patients with pulmonary hypertension associated with chronic obstructive pulmonary disease (PH-COPD) through a systematic review and network meta-analysis. Material and methods: We searched 8 databases for randomized controlled trials (RCTs) involving Statins in individuals with PH-COPD from inception to July 1, 2024. We assessed bias using the ROB 2.0 tool and evaluated evidence quality with the CINeMA framework. We employed a Bayesian network meta-analysis approach to assess outcomes including pulmonary artery pressure, exercise tolerance, lung function, oxygenation parameters, inflammatory markers, and vasoactive substances. Using RStudio and other software, we generated forest plots, league tables, and SUCRA curves to evaluate both direct and indirect comparisons. Results: We analyzed data from 41 RCTs involving 3,606 participants. Our analysis revealed that all 5 statins were effective in reducing Systolic Pulmonary Artery Pressure (sPAP) compared to standard treatment(ST). Rosuvastatin was the most effective, significantly lowering sPAP(MD=-8.8; (95%CI -11.68, -5.85)) and IL-6(MD=-16.41; 95%Cl -29.64, -3.04) and improving the 6-Minute Walk Distance (6MWD)(MD=67.03; 95%Cl 2.77, 130.86). Atorvastatin 20 mg was the most effective in improving lung function, increasing PO2, reducing inflammatory markers such as TNF-α and hs-CRP, and lowering ET-1. Finally, Simvastatin 20 mg+ST was identified as the most effective regimen for reducing PCO2 and increasing NO levels. Conclusions: Our study demonstrates that statins are more effective than standard treatment for adults with PH-COPD. Rosuvastatin is the most effective at reducing sPAP. It also improves the 6MWD and lowers IL-6 levels. Additionally, statins have significantly enhanced lung function, oxygenation parameters, and inflammatory markers in PH-COPD patients, with Atorvastatin showing the best performance in these areas.
Keywords: Statins, pulmonary hypertension, chronic obstructive pulmonary disease, Network meta-analysis, Systematic review
Received: 03 Jun 2025; Accepted: 13 Aug 2025.
Copyright: © 2025 Xu, Zhang, Huang, Du and Xu. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Weifang Xu, Department of Endocrinology, Shenzhen Hospital of Guangzhou University of Chinese Medicine, Shenzhen, China
Disclaimer: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.