The Effect of Statins in Patients With Chronic Obstructive Pulmonary Disease (COPD)

Study Overview
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Brief Summary
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Chronic obstructive pulmonary disease (COPD) is a condition of the lungs which results in breathing difficulties due to the lungs becoming inflamed and the airways narrowed. Current treatments have focused on opening up the narrowed airways but, in addition, we know there is increased inflammation in the blood and these patients are at increased risk of heart disease. Statins, simvastatin being one of them, are drugs used to lower cholesterol in the blood but may also reduce inflammation and lower the risk of heart disease. This study will explore whether simvastatin reduces one of the risk factors in patients with COPD in a short term proof of principle study. The key purpose is to determine whether simvastatin improves the pressure and stiffness of the main blood vessels namely the arterial stiffness measure of aortic pulse wave velocity (PWV). In parallel, we will describe changes in airways and / or blood inflammation and change in breathing ability

Official Title
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The Cardiovascular and Inflammatory Effects of Statin Therapy in Patients With COPD

Conditions
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Chronic Obstructive Pulmonary Disease

Intervention / Treatment
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* Drug: Simvastatin
* Drug: Lactose tablet


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Male or female patients aged 45-80 years; Confirmed COPD: FEV1 30-80% predicted, FEV1/FVC<0.7, salbutamol reversibility <12%, supportive smoking history If female of childbearing potential, have a negative serum pregnancy test at screening and use a medically acceptable form of contraception starting at screening and continuing throughout the study (defined as an oral contraceptive, or barrier method combined with a spermicide) Able to attend for regular clinic appointments In opinion of investigator, the patient will be able to comply with the requirements of the protocol Provide written informed consent. Exclusion Criteria: Known hypersensitivity to or side effects relating to previous statin treatment, or current therapy which includes a statin, ezetimibe or fibrate Clinically significant liver function abnormality; alcohol excess Hypercholesterolaemia > or equal to 6.5mmol/L Females who are pregnant, breast feeding, or at risk of pregnancy and not using a medically acceptable form of contraception. Any condition judged by investigator that would cause the study to be detrimental to patient. Conditions: rheumatoid disease/other collagen vascular disease requiring therapy; diabetes mellitus; untreated hypothyroidism; inflammatory bowel disease; other respiratory disease; known alpha 1 antitrypsin deficiency; malignancy; documented history of ischaemic heart disease (IHD); cor pulmonale or known congestive heart failure; patients planning to undergo elective surgery during the study period. Exacerbation in the last 4 weeks. Significant hypoxia (PaO2 <7.3kPa) Known lactose intolerance. Therapies: oral prednisolone for more than 1 week in the last 6 months; disease modifying drugs (Gold/ sulphasalazine etc); weight losing drugs; concomitant use of warfarin, cyclosporine; concomitant administration of potent CYP3A4 inhibitors (e.g. itraconazole, ketoconazole, HIV protease inhibitors, erythromycin, clarithromycin, telithromycin and nefazodone). Use of any investigational drug within four weeks of the baseline visit.

Ages Eligible for Study
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Minimum Age: 45 Years
Maximum Age: 80 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Quadruple


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Placebo Comparator: Lactose tablet<br> | Drug: Lactose tablet<br>* One tablet taken each evening for 6 weeks<br>|
| Active Comparator: Simvastatin 20mg<br> | Drug: Simvastatin<br>* Simvastatin 20mg once daily (in the evening) for 6 weeks<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Change in arterial stiffness as measured by aortic pulse wave velocity (PWV) over study period | Aortic Pulse wave velocity (Sphygmocor, Atcor) | Week 0 (start) and week 6 (end) | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Change in Circulating Inflammatory Mediators over study period |  | Week 0 (Start) and week 6 (End) | 
| Change in distance (metres)walked on 6 minute walking test | together with pre- and post-walk oxygen saturations | week 0 (start) and week 6 (end) | 
| Change in blood total cholesterol, triglycerides, HDL and LDL over study period |  | week 0 (Start) and week 6 (End) | 
| Change in airway inflammatory markers (differential cell count, exhaled nitric oxide and airway cytokines) over study period |  | week 0 and week 6 | 
| Change in lung function: Spirometry - forced expiratory volume in 1 second (FEV1) and forced vital capacity (FVC) |  | week 0 (Start) and week 6 (End) | 
| Change on blood pressure over study period |  | Week 0 (start) and Week 6 (end) | 
| Change in Liver function tests |  | Week 0 (start) and Week 6 (End) | 
| Change in creatine phosphokinase (CPK) over study period |  | Week 0 (start) and Week 6(End) | 
| Change in Handgrip strength over study period |  | Week 0 (start) and Week 6 (end) | 
| Change in blood desmosine over study period |  | Week 0 (Start) and Week 6 (end) | 
| Change in circulating matrix metalloproteinase over study period |  | Week 0 (start) and Week 6 (end) | 
| Baseline arterial stiffness (aortic pulse wave velocity) |  | Week 0 | 
| Baseline airway (differential cell count, exhaled nitric oxide and cytokines)and circulating inflammatory status (cytokines) |  | Week 0 | 
| Baseline matrix metalloproteinase in airway and blood |  | Week 0 |