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Does Statin Use Attenuate Lung Function Decline?

Regarding our article (1), which examines the relationship between statin use and decline in lung function for a cohort of elderly men, Dr. Khazeni and colleagues raise several important questions. First, they ask for clarification of the difference between the results in Table 3 and those given in the RESULTS section. In RESULTS, we report our estimate for the rates of lung function decline in statin users and nonusers after controlling for the confounding variables listed in METHODS (e.g., age, lung diseases). In Table 3, we list the change in lung function without using a model to control for these additional factors, and we call this the "unadjusted change in lung function." We report the unadjusted results to provide assurance that the effect we identified in our model was not accidentally created by adding too many variables. There is no conflict here: we expect the numbers in Table 3 to differ from those in RESULTS because they are different analyses. The important point is that they are similar—and hence the covariate-adjusted results for statins are not an artifact created by our modeling. Second, Khazeni and colleagues asked why the counts in the tables exceed the total number of subjects we are analyzing. In our tables, "n" does not correspond to the number of people, but the total number of visits. We had 803 subjects, and each subject came in for at least two visits, so n > 1,600.

Khazeni and colleagues also point out that the lack of data on the dosage and type of statin used is a limitation of our study. We agree that it would be very informative to examine the effect of statins by dosage and type, but unfortunately we do not have those data. In our article, we point out that a randomized trial will be needed to confirm a possible causal relationship between statin use and decline in lung function, and an investigation of the dose and type of statins would be an important element in determining the existence of a causal effect.

Stacey Alexeeff and Joel Schwartz

Harvard School of Public Health
Boston, Massachusetts

FOOTNOTES

Conflict of Interest Statement: Neither author has a financial relationship with a commercial entity that has an interest in the subject of this manuscript.

REFERENCES

1. Alexeeff SE, Litonjua AA, Sparrow D, Vokonas PS, Schwartz J. Statin use reduces decline in lung function: VA Normative Aging Study. Am J Respir Crit Care Med 2007;176:742–747.[Abstract/Free Full Text]

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