COPD – Statins versus Vitamin D

In the most recent issue of Chest, the journal of record for the American College of Chest Physicians, there appears a letter exchange between a group of physician researchers and the editors of the Chest regarding the use of statin drugs versus Vitamin D for anti-inflammatory purposes among COPD patients. We found the exchange interesting on a couple fronts and thought it was worthy of your attention.

At basic issue in the professional disagreement between the Chest editors and the physician researcher “letter writers” was whether Vitamin D might be a lower cost alternative to statin drugs and might yield fewer side effects and whether Vitamin D should be supplemented and its effects observed before prescribing statins. The letter writing researchers argued that, “Patients with COPD should be considered at high risk of Vitamin D insufficiency because of reduction of outdoor activity, increased glucocorticoids-induced catabolism, impaired activation as a consequence of renal dysfunction, and a lower storage capacity of in muscle and fat due to wasting.” Masticelli L, et al. Statins, Vitamin D and COPD. Chest. 2010 March; 137 (3): 742-743.

That’s a mouthful isn’t it! In non-doctor-speak, this statement means many people with COPD have depressed levels of Vitamin D as a result of lack of physical activity, poor diet, side effects from use of steroid-based bronchodilators and reduced exposure to sunlight (given the lack of regular outdoor physical activity).

This Vitamin D deficiency depresses immunity, contributes to inflammation that affects a person’s ability to breathe fully, and increases the risk of osteoporosis (decay of bone strength). In the letter writing researchers’ point of view, supplementing Vitamin D has been shown to positively impact these particular health concerns as well as reducing the risk of falling among elderly COPD patients. They further argue that the side effects of statin drugs include depressed muscle performance, and increase the risk of falling among elderly COPD patients.

Given the increased osteoporosis risk created by Vitamin D deficiency in COPD patients, the researchers’ point is that Vitamin D supplementation may provide the same kinds of anti-inflammatory benefits that statin drugs provide but without the risk of increasing the possibility of life-altering falls.

On the other side of the debate lie the Chest editors whose journal recently published the review of statin studies in COPD patients that the letter writing researchers had challenged. (Janda S, et al. Statins in COPD: a systematic review. Chest. 2009 Sep; 136(3): 734-43). While the editors acknowledged that Vitamin D supplementation might provide an “intriguing consideration” as an option to statin drugs, the editors held fast to the notion that more research is needed to prove the efficacy of Vitamin D in comparison to statin drugs for a number of health benefits COPD patients have evidenced in taking statin drugs (benefits identified in the review article Chest published as positively impacting exacerbation rates, pulmonary function, exercise capacity and COPD mortality).

The editors acknowledge that statins do have side effects and concede that the letter writing researchers have raised an interesting point that deserves more investigation and they further suggest that instead of viewing Vitamin D supplementation as a replacement to statins for elderly COPD patients, that more research should examine their complementary use.

This type of professional exchange between rival points of view occurs in medical research constantly but often the debate does not find its way to the very people who the research is intended to help. As you manage your condition (whether you have COPD or are simply concerned about chronic shortness of breath), it is valuable from our point of view to share such debates with you so that you can be better informed about your options.

In our view, whether you take statins or not, it is worth discussing Vitamin D supplementation with your doctor. To assist you in that conversation, we’ve previously written about Vitamin D supplementation for COPD patients (see our blog article of February 2, 2010 by clicking here). In that posting we identified the specific form and dosage levels of Vitamin D (Vitamin D3) that have been examined in COPD related studies. After talking with your doctor, if you are interested in adding or increasing supplemental Vitamin D to your daily healthy living routine, you can find Vitamin D3 in retail outlets and online for between $5-$20 per 30-day supply depending on the dosage level you desire and whether other ingredients have been added (such as Calcium or Vitamin K). In our Breathe Better Marketplace site, powered by Amazon.com, we’ve linked to an array of Vitamin D3 products offered through Amazon as a resource for your product research and price comparisons. You can access the Breathe Better Marketplace by clicking here.