Efficacy and Safety of Atorvastatin as Adjunctive Treatment in Chronic Obstructive Pulmonary Disease: A Systematic Review and Meta-Analysis

BackgroundAccumulating evidence suggests that atorvastatin, a widely used lipid-lowering agent, may provide additional benefits for chronic obstructive pulmonary disease (COPD) patients, including anti-inflammatory effects and improved lung function. However, inconsistent findings across studies warrant a systematic evaluation to clarify its clinical role. ObjectiveTo systematically evaluate the efficacy and safety of atorvastatin as an adjunctive treatment for COPD and inform clinical decision-making. MethodsA comprehensive search of PubMed, EMBASE, Web of Science, Cochrane Library, CNKI, WanFang, CBM, and VIP databases identified randomized controlled trials (RCTs) up to May 20, 2024. Meta-analysis using RevMan 5.3 and R software was performed to estimate pooled effects with mean differences or standardized mean differences (95% CI). Subgroup analyses explored variations by treatment duration and dosage. ResultsTwenty-four RCTs involving 2,534 patients demonstrated significant benefits of atorvastatin for stable COPD and acute exacerbations (AECOPD):Lung function: FEV1%pred increased by 5.36% (95% CI: 4.57-6.14), FEV1/FVC by 6.30% (95% CI: 4.46-8.14), and FEV1 by 0.21 L (95% CI: 0.15-0.27).Inflammatory markers: CRP decreased by 1.87 mg/L (95% CI: 1.45-2.29), with reductions in hs-CRP and IL-6.Quality of life: CAT scores improved by 3.5 points (95% CI: 2.8-4.2).Exercise capacity: The 6-minute walk distance increased by 25.4 meters (95% CI: 18.1- 32.7).Stronger evidence emerged with 3-month treatments (I{superscript 2} < 30%) and consistent benefits at 20 mg doses. Adverse events were mild and self-limiting. ConclusionAtorvastatin (20 mg) significantly improves lung function, reduces inflammation, and enhances quality of life in COPD patients, with a favorable safety profile. Although not currently recommended in COPD guidelines, these findings support further trials to validate its potential role in COPD management.