Statins Are Associated with Improved 28-day Mortality in Patients Hospitalized with SARS-CoV-2 Infection

Abstract

Background: Statins may be protective in viral infection and have been proposed as treatment in severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection. Objective: We evaluated the effect of statins on mortality in four groups hospitalized with (SARS-CoV-2) infection (continued statin, newly initiated statin, discontinued statin, never on statin). Design: In a single center cohort study of 1179 patients hospitalized with SARS-CoV-2 infection, the outcome of death, Intensive Care Unit (ICU) admission or hospital discharge was evaluated. Patients statin use, laboratory data, and co-morbidities were determined via chart review and electronic health records. Using marginal structural models to account for timing of statin initiation and competing risks, we compared the likelihood of severe outcomes in the four statin exposure groups. Setting: Academic medical center in the United States Participants: Patients hospitalized with SARS-CoV-2 infection Measurements: 28-day mortality, ICU admission, or discharge Results: Among 1179 patients, 360 were never on a statin, 311 were newly initiated on a statin, 466 were continued on a statin, and 42 had a statin discontinued. In this cohort, 154 (13.1%) patients died by 28-days. With marginal structural model analysis, statin use reduced the hazard of 28-day mortality (HR 0.566 [CI 0.372, 0.862], p = 0.008). Both new initiation of statins (HR 0.493 [CI 0.253, 0.963], p=0.038) and continuing statin therapy reduced the hazard of 28-day mortality (HR 0.270 [CI 0.114, 0.637], p=0.003). Sensitivity analysis found that statin use was associated with improved mortality for patients > 65 years, but not for patients 65 years or younger. Limitation: Observational design Conclusion: Statin therapy during hospitalization for SARS-CoV-2 infection, including new initiation and continuation of therapy, was associated with reduced short-term mortality.

Statin withdrawal and treating COVID‐19 patients

“…This has been confirmed in two studies that compared continuing versus not continuing statin treatment after hospital admission (Table 1 ). 10 , 11 …”

Statin Withdrawal and Treating COVID-19 Patients

“…However, those who had been treated with statins as outpatients but whose treatment was withdrawn after hospital 1). 10,11 Remarkably, all of the 42 individual studies based on outpatientdocumented statin treatment failed to mention the possible effects of statin withdrawal after hospital admission. For example, in one study, outpatient statin treatment was associated with decreased mortality, but only 77% of outpatient-treated patients continued statin treatment after hospital admission.…”

Targeting proprotein convertase subtilisin/kexin type 9 (PCSK9): from bench to bedside

“…215,216 However, statins have also been observed to substantially improve the outcomes of COVID-19 patients over 65 years old. [217][218][219] This may be attributed to statins' ability to enhance endothelial cell functions and reduce vascular coagulation and inflammation through both cholesterol-dependent and independent mechanisms. 220 Given that PCSK9 mAbs can further significantly decrease LDL-C by about 60% and substantially reduce the incidence of CVEs in patients treated by statin therapy, it has been suggested to also administer PCSK9-iTs to selected COVID-19 patients who could benefit from increased IFN levels.…”