Statins may improve mortality in hospitalized patients with COVID-19
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Antecedent statin therapy conferred improved 30-day in-hospital mortality among patients admitted for COVID-19, despite those patients being older with greater CVD burden compared with those not on statins, researchers reported.
However, the need for invasive mechanical ventilation was no different between the two groups, according to the study published in Nature Communications.
“COVID-19 can result in a hyperinflammatory state, leading to acute respiratory distress syndrome (ARDS), myocardial injury and thrombotic complications, among other sequelae,” Aakriti Gupta, MD, cardiologist at NewYork-Presbyterian/Columbia University Irving Medical Center, and colleagues wrote. “Statins, which are known to have anti-inflammatory and antithrombotic properties, have been studied in the setting of other viral infections, but their benefit has not been assessed in COVID-19.”
For the retrospective study, researchers analyzed 2,626 patients admitted with COVID-19 to the Columbia University Irving Medical Center and Allen Hospital sites of the NewYork-Presbyterian Hospital from Feb. 1 to May 12, 2020, to determine the effect of statin therapy on outcomes in COVID-19. The primary endpoint was in-hospital mortality within 30 days, and the secondary endpoint was invasive mechanical ventilation at 30 days.
Baseline characteristics
Overall, patients on statins were older (median age, 70 vs. 62 years) than those not on statins. There were no significant differences in sex (P = .06) or race/ethnicity (P = .12).
Patients in the statin group were more likely to have the following compared with nonusers:
- hypertension (74% vs. 43.3%);
- diabetes (55.8% vs. 26.1%);
- CAD (22.5% vs. 6.9%);
- HF (17% vs. 6.7%);
- chronic kidney disease (22% vs. 9.6%);
- history of stroke or transient ischemic attack (13.9% vs. 5.6%); and
- atrial arrhythmias (11% vs. 5.6%).
In addition, 77% of patients on antecedent statins and 8.6% of patients not on antecedent statins received statins during COVID-19 hospitalization.
In a propensity-matched analysis, researchers found that patients who were on statins had lower white blood cell count at presentation and lower C-reactive protein levels (P for both < .01).
There no differences in levels of high-sensitivity troponin T, D-dimer, ferritin or erythrocyte sedimentation rate between the groups.
Statins and 30-day mortality
Researchers found that statin use was associated with a reduction in the primary endpoint in the overall cohort in univariate (adjusted OR = 0.69; 95% CI, 0.56-0.85) and multivariable-adjusted analysis (aOR = 0.49; 95% CI, 0.38-0.63) compared with nonuse.
“There are many potential explanations as to how statins may have contributed to lower 30-day in-hospital mortality in our cohort,” the researchers wrote. “Statins, which target HMG-CoA (3-hydroxy-3-methylglutaryl coenzyme A) reductase, confer a significant mortality benefit in patients with atherosclerotic cardiovascular disease who are overrepresented in hospitalized patients with COVID-19. In addition to hyperlipidemia and other cardiovascular risk factors, inflammation has been identified as a key modulator of atherogenesis and can contribute to adverse cardiovascular events.”
According to the study, antecedent statin use was associated with lower rates of in-hospital mortality at any time compared with nonuse (20.8% vs. 33.7%; P < .001).
There was a trend toward statins being linked to lower odds of the secondary endpoint (aOR = 0.8; 95% CI, 0.64-1.02).
“Identifying treatment strategies to prevent serious sequelae of this viral infection may have the potential to improve prognosis,” the researchers wrote. “The current analysis suggests that statins merit further evaluation in COVID-19 given their pleiotropic properties and potentially disease-modifying effects in the setting of this viral illness.”
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