Association Between Antecedent Statin Use and Decreased Mortality in Hospitalized Patients with COVID-19

Abstract

The coronavirus disease 2019 (COVID-19), caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), can result in a hyperinflammatory state, leading to acute respiratory distress syndrome (ARDS), myocardial injury, and thrombotic complications, among other sequelae. Statins, which are known to have anti-inflammatory and antithrombotic properties, have been studied in the setting of other viral infections and ARDS, but their benefit has not been assessed in COVID-19. Thus, we sought to determine whether antecedent statin use is associated with lower in-hospital mortality in patients hospitalized for COVID-19. This is a retrospective analysis of patients admitted with COVID-19 from February 1st through May 12th, 2020 with study period ending on June 11th, 2020. Antecedent statin use was assessed using medication information available in the electronic medical record. We constructed a multivariable logistic regression model to predict the propensity of receiving statins, adjusting for baseline socio-demographic and clinical characteristics, and outpatient medications. The primary endpoint included in-hospital mortality within 30 days. A total of 2626 patients were admitted during the study period, of whom 951 (36.2%) were antecedent statin users. Among 1296 patients (648 statin users, 648 non-statin users) identified with 1:1 propensity-score matching, demographic, baseline, and outpatient medication information were well balanced. Statin use was significantly associated with lower odds of the primary endpoint in the propensity-matched cohort (OR 0.48, 95% CI 0.36 – 0.64, p<0.001). We conclude that antecedent statin use in patients hospitalized with COVID-19 was associated with lower inpatient mortality. Randomized clinical trials evaluating the utility of statin therapy in patients with COVID-19 are needed.

Intermediate versus standard-dose prophylactic anticoagulation and statin therapy versus placebo in critically-ill patients with COVID-19: Rationale and design of the INSPIRATION/INSPIRATION-S studies

“…In turn, the hypothesis tested in INSPIRATION-S will assess whether targeting thromboinflammatory pathways with atorvastatin has the potential to mitigate the clinical outcomes [44,45]. Results from several additional ongoing statin trials (Fig.…”

Diabetes, obesity, metabolism, and SARS-CoV-2 infection: the end of the beginning

“…Analysis of electronic medical records for antecedent statin use prior to hospitalization in 2,626 individuals with COVID-19 revealed 951 statin users, who were more likely to report a history of T2D, kidney disease, hypertension, coronary artery disease, and heart failure ( Gupta et al., 2020 ). In hospital, statin use was documented for 77% of subjects with a history of prior statin use versus 8.6% of control subjects without a history of antecedent prescriptions for statin therapy.…”

“…Consistent with statin history, levels of total and LDL cholesterol were lower in individuals with antecedent statin use. Comparison of outcomes in propensity-matched cohort subgroups revealed that antecedent statin use was associated with reduced levels of CRP on admission and decreased in-hospital mortality (the primary study endpoint) as well as a composite secondary outcome of reduced need for mechanical ventilation or mortality within 30 days of hospitalization ( Gupta et al., 2020 ).…”

“…Gupta et al. analyzed the electronic medical records of 2,626 patients with COVID-19 hospitalized in several NY hospitals between February 1 and May 12, 2020, with 36.2% of subjects on statins prior to admission ( Gupta et al., 2020 ). Statin-treated subjects were older, had lower levels of total and LDL cholesterol, and were more likely to have previous hypertension, coronary artery disease, heart failure, and CKD.…”

Protective Effects of Statins Administration in European and North American Patients Infected with COVID-19: A Meta-Analysis

“…The result of the meta-analysis of these seven studies performed in Western countries are reported in ►Fig. 2, [35][36][37][38][39][40][41] which demonstrate that COVID-19 patients taking statins had nearly 40% lower odds of progressing to the composite endpoint of severe/critical illness or death (OR: 0.59; 95% CI: 0.35-0.99; Cochran's Q p ¼ 0.02; I 2 ¼ 60%). Individually, six of these seven studies reported a reduced OR (i.e., OR < 1; protective effect of statins), [35][36][37][38][39][40] while in only one study was the OR >1 (i.e., OR: 1.60; 95% CI: 0.88-2.92).…”