| Home | E-Submission | Sitemap | Contact Us |  
Clinical and Experimental Otorhinolaryngology > Volume 16(1); 2023 > Article
Min, Lee, Doo, Kim, and Min: The Effects of Statin Medications on Postoperative Outcomes in Patients With Chronic Rhinosinusitis
Statins are inhibitors of 3-hydroxy-3-methylglutaryl-CoA (HMGCoA) reductase, the rate-limiting enzyme in cholesterol biosynthesis. They are often prescribed as cholesterol-lowering agents to reduce cardiovascular morbidity and mortality. However, the reduction in low-density lipoprotein-cholesterol levels alone does not fully explain the improvement in cardiovascular disease with statin use. Statins also exert benefits through their ability to modulate several inflammatory mechanisms involved in the atherosclerotic process [1,2].
Byproducts released by processes in cholesterol biosynthesis also serve as biologically active inflammatory mediators involved in innate and adaptive immunity. Airway inflammation is regulated by these mediators, and statins have also been reported to induce anti-inflammatory effects in human airway epithelial inflammation, as takes place in asthma or chronic rhinosinusitis (CRS) [3]. In addition, a lower prevalence of CRS and a reduced risk of acute exacerbations of asthma were reported in patients taking statins [4-6]. Thus, we investigated the effect of statins on postoperative outcomes in patients with CRS who underwent endoscopic sinus surgery (ESS).
We retrospectively reviewed the electronic medical records of 380 patients (82 patients taking statins and 298 patients without statin use) diagnosed with CRS with and without nasal polyps who underwent unilateral/bilateral functional ESS at single center between 2017 and 2021. All CRS patients satisfied the clinical criteria of the European Position Paper on Rhinosinusitis and Nasal Polyps [7]. Patients who were diagnosed with sinonasal tumors (e.g., inverted papilloma, angiofibroma, Natural killer (NK)/T cell lymphoma, odontogenic cyst, mucocele, postoperative cheek cyst, etc.) or fungal rhinosinusitis on a histological examination or had a history of head and neck malignancy or radiation therapy were excluded. The statin-taking group was defined as those who were already taking statins, such as atorvastatin, rosuvastatin, simvastatin, pravastatin, or pitavastatin, at their first visit to the outpatient clinic, regardless of whether the statin prescriptions were from our hospital or other hospitals. Revision surgery was defined as cases where one or more operations were performed other than the operation at the time of investigation by patients’ reports or medical records. In addition, uncontrolled CRS was defined as the presence of symptoms suggesting CRS and the prescription of rescue medication (antibiotics and/or oral steroids) and/or the performance of an additional operation at least 3 months after surgery. All data were analyzed using IBM SPSS ver. 20.0 statistical software (IBM Corp.). This study was conducted in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. This study was approved by the Human Investigation Committee of Kyung Hee University (No. 2021-11-011), and informed consent was waived due to retrospective nature of this study.
First, we sought to identify the factors associated with the need for revision surgery. In the univariate analysis, statin use tended to be inversely correlated with the necessity of revision surgery (odds ratio [OR], 0.430; P=0.068) (Table 1). Interestingly, the multivariate analysis showed that statin use was significantly associated with a lower rate of revision surgery (adjusted OR, 0.412; P=0.038) (Table 1).
The preoperative eosinophil count, eosinophil cationic protein (ECP), and total immunoglobulin (Ig)E in serum were significantly higher in the statin-free group than in the statin-taking group (P<0.05 for all) (Table 2), although there was no significant difference in comorbid allergic diseases, including asthma and allergies, between the two groups (P>0.05 for all) (Table 2). Notably, we found a significantly lower rate of uncontrolled disease in statin-taking CRS patients than in CRS patients without statins (31.71% vs. 44.97%, P=0.031, respectively) (Table 2).
In terms of subjective and objective measurements such as the Lund-Mackay score, Sinonasal Outcome Test, the total nasal symptom score, the Lund-Kennedy endoscopic scores (L-K scores), and olfactory function test (Korean version of the Sniffin’ Sticks test II), no significant differences were found between the statin-taking and statin-free groups preoperatively. Regarding postoperative outcomes, we found that the statin-taking group showed significantly lower mean L-K scores for discharge than the statinfree group at 6 months (0.15±0.50 vs. 0.40±0.78, P=0.033) and 12 months (0.16±0.52 vs. 0.46±0.79, P=0.049) after surgery.
In this study, we found that statin use might have a beneficial effect on reducing the recurrence rate of CRS and improving the L-K score for discharge after ESS. The prevalence of CRS was reported to be 0.719–0.79 times lower in patients taking statins than in those not taking statins in previous studies conducted in the United States [4,5].
Anti-inflammatory and immunomodulatory effects of statins in the airway epithelium have recently been shown. In an in vitro study with human sinus tissues from CRS patients, the expression of inflammatory mediators such as CCL5, CCL11, and IL13RA was suppressed in patients taking statins [3]. Statins also regulated small G proteins/MAP kinases/nuclear factor kappa B (NF-κB) acting on various allergic responses in a mouse allergic asthma model [8]. Given these results, we hypothesized that statin use might modulate inflammatory responses in the nasal epithelium, resulting in protective effects on recurrence after surgery in patients with CRS. Interestingly, we demonstrated that the eosinophil count, ECP, and total IgE in serum were significantly higher in the statin-free group. Supporting our results, in a mouse model, both pravastatin and atorvastatin inhibited Th1- and Th2-mediated antibody responses, thereby reducing serum-specific IgE, IgG, IgG1, and IgG2a levels, which effectively regulated airway hypersensitivity [9].
Regardless of statin use, no significant between-group differences were found in either preoperative subjective symptoms or objective findings, suggesting that statin use alone did not modify CRS severity. Unlike the preoperative findings, the L-K score for discharge was significantly lower in the statin-taking group than in the statin-free group 6 and 12 months after surgery. It has been reported that statins suppress airway mucus secretion via inhibition of interleukin-13, which may be responsible for goblet cell hyperplasia and MUC5AC mRNA expression [10]. Although statins do not show a strong effect on the severity of CRS, they are expected to play an auxiliary role in maintaining improvements in CRS patients after surgery. Nevertheless, this was a retrospective study, and we could not analyze the effect of the administration duration or the type of statin. Moreover, we did not establish a direct mechanism through which statins exert beneficial effects on postoperative outcomes. Future studies are required to elucidate these mechanisms.
In conclusion, our results demonstrated that statin use was associated with a lower rate of revision surgery and uncontrolled disease in patients with CRS. Furthermore, statins showed additive beneficial effects on the L-K score for discharge after ESS, suggesting that statins might be of potential therapeutic value to enhance the postoperative outcomes of ESS in patients with CRS.


No potential conflict of interest relevant to this article was reported.



Conceptualization: JYM. Data curation: HJL, JGD. Investigation: HKM. Funding acquisition: JYM. Methodology: HKM. Project administration: JYM. Supervision: JYM. Visualization: HJL, JGD. Writing–original draft: HKM. Writing–review & editing: JYM, SWK, HKM.


This work was supported by a grant from Kyung Hee University in 2021 (No. KHU-20210149) and a grant from the National Research Foundation of Korea (NRF-2019R1F1A1057975 to JYM).

Table 1.
Factors associated with the need for revision surgery
Variable Univariate analysis
Multivariate analysis
Odds ratio (95% CI) P-value Adjusted odds ratio (95% CI) P-value
Age 1.007 (0.988–1.028) 0.464 NA
Sex 0.736 (0.361–1.503) 0.400 NA
Alcohol 1.526 (0.814–2.861) 0.188 NA
Smoking 0.983 (0.495–1.951) 0.960 NA
HTN 0.735 (0.353–1.527) 0.409 NA
DM 2.561 (0.930–7.055) 0.069 2.506 (0.930–6.750) 0.069
Dyslipidemia 0.677 (0.171–2.684) 0.579 NA
Asthma 3.131 (1.579–6.210) 0.001* 2.762 (1.433–5.324) 0.002*
Allergy 0.722 (0.407–1.278) 0.263 NA
Nasal polyp 1.864 (1.008–3.447) 0.047* 1.945 (1.060–3.571) 0.032*
Statin medication 0.430 (0.174–1.064) 0.068 0.412 (0.179–0.951) 0.038*

CI, confidence interval; NA, not available; HTN, hypertension; DM, diabetes mellitus.

* P<0.05.

Table 2.
Differences between the statin-taking and statin-free group
Variable Statin-taking (n=82) Statin-free (n=298) P-value
Positive result of allergy tests 35 (42.68) 157 (52.68) 0.109
Number of patients with asthma 12 (14.63) 44 (14.77) 0.976
CRSwNP 51 (62.20) 180 (60.40) 0.768
 Eosinophil count 206.92±173.85 279.56±247.66 0.013*
 ECP (ng/mL) 19.01±16.46 30.33±30.17 0.004*
 Total IgE (IU/mL) 161.60±307.45 303.25±601.15 0.042*
 Total cholesterol (mg/dL) 157.40±38.43 194.00±36.95 0.000*
Rescue medication 20 (24.40) 102 (34.23) 0.088
Uncontrolled CRS 26 (31.71) 134 (44.97) 0.031*
Follow-up duration (mo) 10.82±6.93 11.09±8.49 0.791

Values are presented as number (%) or mean±standard deviation.

CRSwNP, chronic rhinosinusitis with nasal polyp; ECP, eosinophil cationic protein; IgE, immunoglobulin E; CRS, chronic rhinosinusitis.

* P<0.05.


1. Ascer E, Bertolami MC, Venturinelli ML, Buccheri V, Souza J, Nicolau JC, et al. Atorvastatin reduces proinflammatory markers in hypercholesterolemic patients. Atherosclerosis. 2004 Nov;177(1):161-6.
crossref pmid
2. Case CC, Ballantyne CM. Statins and inflammatory markers. Curr Atheroscler Rep. 2002 Jan;4(1):42-7.
crossref pmid pdf
3. Wang W, Le W, Ahuja R, Cho DY, Hwang PH, Upadhyay D. Inhibition of inflammatory mediators: role of statins in airway inflammation. Otolaryngol Head Neck Surg. 2011 Jun;144(6):982-7.
4. Wilson JH, Payne SC, Fermin CR, Churnin I, Qazi J, Mattos JL. Statin use protective for chronic rhinosinusitis in a nationally representative sample of the United States. Laryngoscope. 2020 Apr;130(4):848-51.
crossref pmid pdf
5. Gilani S, Bhattacharyya N. The potential protective effects of statins in chronic rhinosinusitis: a case-control study. Laryngoscope. 2021 May;131(5):E1431-3.
crossref pmid pdf
6. Kim JH, Wee JH, Choi HG, Park JY, Hwang YI, Jang SH, et al. Association between statin medication and asthma/asthma exacerbation in a national health screening cohort. J Allergy Clin Immunol Pract. 2021 Jul;9(7):2783-91.
crossref pmid
7. Fokkens WJ, Lund VJ, Hopkins C, Hellings PW, Kern R, Reitsma S, et al. European Position Paper on rhinosinusitis and nasal polyps 2020. Rhinology. 2020 Feb;58(Suppl S29):1-464.

8. Kim DY, Ryu SY, Lim JE, Lee YS, Ro JY. Anti-inflammatory mechanism of simvastatin in mouse allergic asthma model. Eur J Pharmacol. 2007 Feb;557(1):76-86.
crossref pmid
9. Huang CF, Peng HJ, Wu CC, Lo WT, Shih YL, Wu TC. Effect of oral administration with pravastatin and atorvastatin on airway hyperresponsiveness and allergic reactions in asthmatic mice. Ann Allergy Asthma Immunol. 2013 Jan;110(1):11-7.
crossref pmid
10. Liou CJ, Cheng PY, Huang WC, Chan CC, Chen MC, Kuo ML, et al. Oral lovastatin attenuates airway inflammation and mucus secretion in ovalbumin-induced murine model of asthma. Allergy Asthma Immunol Res. 2014 Nov;6(6):548-57.
crossref pmid pmc
Editorial Office
Korean Society of Otorhinolaryngology-Head and Neck Surgery
103-307 Park Tower officetel, Yongsan-dong 5-ga, Yongsan-gu, Seoul 04385, Korea
TEL: +82-2-711-9091   FAX: +82-2-3487-6603   E-mail: editor.eceo@gmail.com
Copyright © Korean Society of Otorhinolaryngology-Head and Neck Surgery.                 Developed in M2PI
Close layer
prev next