Effects of atorvastatin on inflammatory markers, lipid profile, liver enzymes, and pulmonary function in patients with lung diseases: a systematic review and meta-analysis of randomized controlled trials

TL;DR

This study reviews how atorvastatin affects inflammation, cholesterol, and lung function in patients with lung diseases, finding some benefits but also potential evening airflow issues.

Contribution

The study provides a meta-analysis of atorvastatin's effects on multiple biomarkers and pulmonary function in diverse lung diseases.

Findings

Atorvastatin significantly reduced TNF-α and LDL cholesterol in lung disease patients.

It improved 6MWD and FEF25-75 in COPD subgroups but worsened evening peak expiratory flow.

No significant effects were observed for CRP, IL-6, triglycerides, HDL, FEV1, FVC, or oxygen saturation.

Abstract

Pulmonary diseases are important causes of morbidity globally. Atorvastatin's pleiotropic effects, which include anti-inflammatory and lipid-lowering properties, may be beneficial for individuals with respiratory diseases. This meta-analysis evaluated the atorvastatin's effect on inflammatory biomarkers, lipid profile, liver enzymes, and pulmonary function in lung disease patients.

We systematically searched PubMed/MEDLINE, Scopus, Web of Science, Embase, CENTRAL, and Google Scholar for English-language RCTs until March 2025. The study evaluated inflammatory markers (CRP, IL-6, TNF-α), lipid profile (LDL, HDL, TC, TG), liver enzymes (ALT, AST), pulmonary function tests, and physical performance. Pooled weighted mean differences (WMDs) with 95% confidence intervals were calculated using random-effects models. Subgroup, heterogeneity, and publication bias analyses were conducted.

Seventeen RCTs (22 datasets; n = 1,344) on asthma, COPD, COVID-19, pulmonary hypertension, and associated disorders were analyzed. Atorvastatin substantially decreased TNF-α (WMD: − 0.20 pg/mL; 95% CI − 0.28 to − 0.11), LDL cholesterol (WMD: − 21.48 mg/dL; 95% CI − 30.82 to − 12.14), and TC (WMD: − 15.24 mg/dL; 95% CI − 28.28 to − 2.20), while improving 6MWD (WMD: 0.71; 95% CI 0.24 to 1.17) and FEF25-75 in COPD subgroups. Evening peak expiratory flow (PEF) was considerably lower (WMD: − 8.72; 95% CI − 14.96 to − 2.47), indicating worsening in airway airflow throughout the evening. There were no significant overall effects for CRP, IL-6, triglycerides, HDL, FEV1, FVC, or oxygen saturation.

Atorvastatin demonstrates anti-inflammatory and lipid-lowering efficacy in pulmonary disease patients, with mild functional respiratory benefits and modest improvements in physical performance. Additional large-scale studies are needed to validate clinical benefits and effective treatment methods.

The online version contains supplementary material available at 10.1186/s40001-025-03782-y.

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