| Background Pulmonary hypertension (PH) is a common, complex and progressive disease. Increased pulmonary vascular resistance leads to right heart failure and finally even death. An American study showed that the median survival time for patients with untreated idiopathic pulmonary arterial hypertension (IPAH) was 2.8 years. So far there is still no cure for PH. In the last decades, there were three pulmonary-specific drugs approved for PH including prostanoids, endothelin-1 (ET-1) receptor antagonists and phosphodiesterase-type 5 (PDE5) inhibitors. However, these three drugs are too expensive and neither convenient nor safe enough.Statins are HMG-CoA (Hydroxymethylglutaryl-Coenzyme A) reductase inhibitors which were used for lowing serum cholesterol by inhibiting HMG-CoA reductase (the rate-limiting step in cholesterol synthesis) and had been used for many years in the treatment of hypercholesterolemia. Studies had identified the pleiotropic effects of statins beyond their cholesterol-lowering properties. More and more evidence of animal trials and clinical studies suggest that statins appear to attenuate the pulmonary vascular structural remodeling and inhibite vascular smooth muscle proliferation as a novel drug in treating PH.Objectives We conducted a Meta-analysis of treatments for PH, aiming at evaluating the therapeutic effects of statins in patients with PH through all randomized controlled trials (RCTs) on the therapeutic yield of statins in PH. Methods A total of 9 RCTs were identified to assess the effects of statins on PH by searching PubMed and CNKI (both inception to December 2010). The methodological quality of included RCTs was made using Jadad scale. Efficacy measures include 6-minute-walk distance (6 MWD), cardiac index (CI), mean pulmonary artery pressure (mPAP), systolic pulmonary artery pressure (sPAP), PaO2, plasma NO, plasma ET-1, systolic blood pressure (systolic BP) and diastolic blood pressure (diastolic BP). RevMan 5.0 was used for analying datas.Results Nine RCTs involving a total of 590 people with PH were included in this Meta-analyses. The results of Meta-analyses showed that (1) Systolic pulmonary arterial pressure (mPAP) decreased by 5.41mmHg (95%CI[-6.73,-4.09], P<0.00001); (2) Mean pulmonary arterial pressure (mPAP):mPAP decreased by 3.26mmHg (95%CI[-4.10,-2.42], P<0.00001); (3) Six-minute walk distance (6 MWD):6 MWD increased 31.72m (95%CI[-23.06,86.51], P=0.26); (4) cardiac index (CI):CI increased 0.21L/min m2 (95%CI[0.14,0.27], P<0.00001); (5) Plasma NO:plasma NO increased 4.10μg/L(95%CI[3.51,4.68], P<0.00001); (6) Plasma ET-1:plasma ET-1 decreased by 1.31pg/ml (95%CI[-3.18,0.56], P=0.17); (7) PaO2:PaO2 decreased by 6.32mmHg (95%CI[-1.07,13.7], P=0.09); (8) Systolic blood pressure (systolic BP):systolic BP decreased by 0.97mmHg (95%CI[-3.29,1.35], P=0.41); (9) Diastolic blood pressure (diastolic BP):diastolic BP decreased by 0.93mmHg (95%CI[-2.22,0.36],P=0.16).Conclusions Our Meta-analyses suggest that statins are effective in treating patients with PH. Statin therapy is associated with an improvement of cardiac function and hemodynamics in patients with PH. Furthermore the results show that statins do not influence systolic BP or diastolic BP of patients with PH. |
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