Statins lower COVID-19 mortality rate for hospitalized adults with diabetes
Adults with diabetes admitted to a New York City hospital with COVID-19 had a lower mortality risk if they received a statin, according to a study published in the Journal of the American Heart Association.
“In this analysis involving a large cohort of hospitalized patients with COVID-19, statin use was associated with reduced in-hospital mortality in patients with diabetes,” Omar Saeed, MD, attending cardiologist at Montefiore Medical Center and assistant professor of medicine at Albert Einstein College of Medicine in New York, and colleagues wrote. “This observation was made despite older age, higher prevalence of hypertension and atherosclerotic heart disease in diabetic statin users.”
Researchers reviewed medical records data from all individuals admitted to Montefiore Medical Center with confirmed COVID-19 from March 1 to May 2. Researchers analyzed in-hospital mortality and separated the study cohort into those who received a statin during hospitalization and those who did not.
A total of 4,252 patients were admitted to the medical center with COVID-19 during the study period (mean age, 65 years; 47% women; 37% Hispanic) with a mean arrival 3 days after the onset of symptoms. Of the total cohort, 32% of individuals received a statin during hospitalization, with 76% of recipients assigned atorvastatin. Overall, the mortality rate for statin recipients was lower than for those who did not receive a statin (23% vs. 27%; P < .01).
There were 2,266 patients with diabetes admitted to the hospital with COVID-19 (mean age, 68 years; 48% women; 36% Hispanic). Of the diabetes group, 43% received a statin. Those with diabetes who were also statin recipients had a lower mortality rate than those who did not receive a statin (24% vs. 39%; P < .01). No difference was found between recipients and nonrecipients for individuals without diabetes. Propensity score matching (HR = 0.88; 95% CI, 0.83-.094) and inverse probability treatment weighting (HR = 0.88; 95% CI, 0.84-0.92) showed those with diabetes who received a statin had a 12% lower risk for in-hospital mortality compared with those who did not have a statin.
In the diabetes group, a greater number of statin recipients had a history of hypertension (91% vs. 84%; P < .01) and atherosclerotic heart disease (46% vs. 28%; P < .01) than nonrecipients. The statin recipient group also had lower C-reactive protein (10.2 mg/dL vs. 12.9 mg/dL; P < .01) and ferratin (683 ng/mL vs. 786 ng/mL; P = .048) at presentation when compared with nonrecipients. Blood glucose level was similar between the two groups.
“Statins are known to have anti-inflammatory effects that are clinically evident through a reduction in inflammatory biomarkers such as C-reactive protein and these effects are also apparent in diabetics,” researchers wrote. “In our cohort, diabetics in the statin group presented with lower inflammatory markers and had reduced mortality. In contrast, there was no difference in inflammatory markers at presentation in nondiabetics either on or off statins. Presuming that in-hospital statin administration was indicative of outpatient usage and adherence, one might speculate that statin therapy blunted the COVID-19 inflammatory response pre-admission as well as during hospitalization, and improved survival was related to ongoing chronic statin use. This hypothesis would have to be prospectively tested.”
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