Discontinuation of atorvastatin use in hospital is associated with increased risk of mortality in COVID‐19 patients

Abstract

Background: Statins are a commonly used class of drugs, and reports have suggested that their use may affect COVID-19 disease severity and mortality risk.Objective: The purpose of this analysis was to determine the effect of discontinuation of previous atorvastatin therapy in patients hospitalized for COVID-19 on the risk of mortality and ventilation.Methods: Data from 146,413 hospitalized COVID-19 patients were classified according to statin therapy. Home + in hospital atorvastatin use (continuation of therapy); home + no in hospital atorvastatin use (discontinuation of therapy); no home + no in hospital atorvastatin use (no statins). Logistic regression was performed to assess the association between atorvastatin administration and either mortality or use of mechanical ventilation during the encounter.Results: Continuous use of atorvastatin (home and in hospital) was associated with a 35% reduction in the odds of mortality compared to patients who received atorvastatin at home but not in hospital (odds ratio [OR]: 0.65, 95% confidence interval [CI]: 0.59-0.72, p < .001). Similarly, the odds of ventilation were lower with continuous atorvastatin therapy (OR: 0.70, 95% CI: 0.64-0.77, p < .001).Conclusions: Discontinuation of previous atorvastatin therapy is associated with worse outcomes for COVID-19 patients. Providers should consider maintaining existing statin therapy for patients with known or suspected previous use.

Treating COVID-19: Targeting the Host Response, Not the Virus

“…Moreover, continuation of ACE inhibitor/ARB outpatient treatment after hospitalization has beneficial effects on COVID-19 outcomes [ 163 ], whereas discontinuing treatment can be harmful [ 164 , 165 , 166 , 167 , 168 ]. Similarly, an increase in COVID-19 mortality has been observed following withdrawal of statin treatment [ 169 , 170 ]. Withdrawal of treatment with these drugs is discussed in greater detail below.…”

Protective effects of statins on COVID-19 risk, severity and fatal outcome: a nationwide Swedish cohort study

“…A hospital-based study in the US showed that the odds of mortality decreased by 35% in statin-users who continued to use statins upon hospital admission for COVID-19 compared with those for which the. statin therapy was discontinued 53 . The effect of discontinuation of statin treatment on the risk of COVID-19 in a population needs to be investigated in further detail.…”

Statin Therapy to Improve Outcome of COVID-19 Patients: Useful or Not Useful?

“…Reduction in the risk of death (up to 28% as evaluated in 2.9 million patients [ 24 ]) was found. Discontinuation of previous statin therapy on hospital admission once diagnosed with COVID-19 could therefore result in a worse outcome (OR, 0.65; 95% CI, 0.59–0.72; p < 0.001) [ 27 ]. Benefits were established in COVID-19 patients previously treated and maintained on statin therapy during hospitalization in comparison to patients in whom therapy was withdrawn on admission.…”