The Corpus Callosum

Statins Prevent Lung Damage?

Nature News reports on a preliminary study href="http://www.chestnet.org/about/press/chest2006/briefing.php">presented
at the annual
meeting of the American College of Chest Physicians
.
 The study indicates that the cholesterol-lowering drugs in
the statin family may protect against lung damage caused by cigarette
smoking.

The study, presented by Walid G. Younis, MD, consisted of data analysis
of results from a survey done on 485 smokers and ex-smokers.
 They found that those who took statins had much
less lung damage.

They compared medical tests of the patients’ lung
health with those done, on average, 2.7 years previously.

The lungs of those who were taking statins fared much better. Their
lung volume, for example, had declined by just over 1% each year
compared with a drop of 10% in the comparison group. “We were really
impressed,” says Younis, who presented the results at the American
College of Chest Physicians meeting in Salt Lake City, Utah.

Although it was a retrospective study, with all the attendant
limitations, the magnitude of the effect was sufficiently impressive
that it seems that it has to mean something.

The hypothetical explanation is fairly straightforward:

Statins block an enzyme called HMG-CoA reductase,
which is involved in the production of various fatty molecules.
Blocking this enzyme lowers cholesterol levels. It also reduces the
concentration of molecules that promote inflammation in response to
irritants such as smoke.

Of course, the real solution to preventing lung damage in smokers is
for them to quit smoking.  But for those who appear to be
unable to do so, this could present an opportunity for harm reduction.
 That, of course, tends to be a highly controversial subject.
  Many addictionologists are href="http://www.aleph.se/andart/archives/2004/04/exporting_the_swedish_snus_model.html">philosophically
opposed to harm reduction strategies.  

In the news article, they mention possible other applications of the
anti-inflammatory properties of statins; for example, they mention
possible uses in asthma and rheumatoid arthritis.  They don’t
mention multiple sclerosis, although there href="http://twotermslater.blogspot.com/2006/04/statins-next-fluoride.html">have
href="http://ms20something.blogspot.com/2006/03/statin-improves-performance-of_18.html">been
studies
on that, as well.  

One thing that occurs to me is that it might be worth trying in cases
of occupational exposure.  There has been a lot of discussion
about the long-term effects of respiratory exposure to the post-9/11
debris in New York.  Could a statin have prevented some of the
morbidity in that situation?  Of course, one cannot arrange a
prospective study of a unique event.  But there are other
kinds of occupational exposure: in coal mines, for example.  

One thing that I would be particularly curious about, would be to see
if patients who have chronic inflammatory conditions would be less
prone to depression, if treated with statins.  One of my
attendings in residency, href="http://www2.med.umich.edu/departments/mott/index.cfm?fuseaction=Peds.facultyBio&individual_id=4982">Ziad
Kronfol, href="http://www.medscape.com/medline/abstract/12466033">was
interested in href="http://www.psychosomaticmedicine.org/cgi/content/full/61/3/263">this
kind of href="http://www.psychopharmacology.net/cytokine.htm">thing.
 Although the basic science research seems far from providing
anything really conclusive, it is interesting, and I do think there are
some practical implications for patient care in this kind of thing.

Sort of as a side note, I worry about the fact that the statins are
starting to become available as generics.  If there are
entirely new areas of therapeutic efficacy that have yet to be
explored, there may not be much funding available to do the studies
that would be needed to establish efficacy.