Effects of Simvastatin on Tissue Factor Pathway of Blood Coagulation in STATCOPE (Simvastatin in the Prevention of COPD Exacerbations) Trial.

BACKGROUND Statins are widely used to lower lipids and reduce cardiovascular events. In vitro studies and small studies in patients with hyperlipidemias show statins inhibit tissue factor (TF) and blood coagulation mechanisms. We assessed the effects of simvastatin on TF and coagulation biomarkers in patients entered in STATCOPE, a multicenter, randomized, placebo-controlled trial of simvastatin (40 mg daily) versus placebo on exacerbation rates in patients with chronic obstructive pulmonary disease (COPD). METHODS In 227 patients (114 simvastatin; 113 placebo; mean (±SEM) age 62 ± 0.53 years, 44.5 % women) we measured (baseline; 6 and 12 months): whole blood membrane TF-procoagulant activity (TF-PCA) and plasma factors VIIa, VII, VIII, fibrinogen, TF antigen, tissue factor pathway inhibitor (TFPI), thrombin-antithrombin complexes (TAT) and D-dimer. We excluded patients with diabetes, cardiovascular disease and those taking or requiring a statin. RESULTS In the statin group, there was a small increase in TF-PCA (from 25.18±1.08 to 30.36±1.10 U/ml; p=0.03) over 12 months; factors VIIa and VIII, fibrinogen, TAT and D-dimer did not change. Plasma TFPI (from 52.4±1.75 to 44.7±1.78 ng/mL; p< 0.0001) and FVIIC (1.23±0.04 to 1.15±0.03 U/mL; p=0.03) decreased and correlated with total cholesterol levels. No changes in biomarkers were observed with placebo. CONCLUSIONS In contrast to previous studies on statins, in COPD patients without diabetes, cardiovascular disease or requiring a statin treatment, simvastatin (40 mg per day) did not decrease TF or factors VIIa and VIII, fibrinogen, TAT or D-dimer. The decreases in TFPI and factor VII reflect the decrease in serum lipids.