The role of pravastatin in pulmonary hypertension in chronic obstructive pulmonary disease

Tamera Jo Corte (1) , Stephen John Wort

1 Department of Pulmonary Hypertension

In this issue of Clinical Science Lee et al report a placebo-controlled study of 53 patients with chronic obstructive pulmonary disease (COPD) and pulmonary hypertension (PH) on echocardiography, in which six-months of pravastatin treatment was associated with a significant increase in exercise time (660 to 1006s, p<0.0001) and improvement in Borg dyspnoea score. COPD is clearly a significant health concern as the fourth leading cause of morbidity and mortality in the US, costing up to £1 billion per year in the UK. The exact prevalence of PH in COPD is uncertain. However, it is estimated that mean pulmonary artery pressure will rise on average by 0.28 to 0.6 mmHg per year per patient, so occurring in up to 95% of patients awaiting lung volume reduction surgery or transplantation. However, PH in this context is usually mild to modest in severity, except for a small number with COPD ‘out-of-proportion' to their underlying airflow limitation. Certainly, the presence of PH is a risk factor for mortality in patients with COPD. We review the role of PH in COPD and its pathophysiology, with reference to endothelin-1, cigarette smoke, as well as exercise and nocturnal hypoxia. We also explore potential mechanisms for the observed improvement in exercise tolerance seen in six months' pravastatin treatment, including possible effects upon endothelin-1, Rho-kinase, or antioxidant effects, which may be particularly relevant in this group of mainly current smokers.

Mots clés: Medicine

Tamera Jo Corte, Stephen John Wort. The role of pravastatin in pulmonary hypertension in chronic obstructive pulmonary disease. Clinical Science, 2009, 116 (6), pp.493-495. ⟨10.1042/CS20080590⟩. ⟨hal-00479452⟩