Statins have proven to have anti-inflammatory and antithrombotic properties that aid in other viral infections, leading many to believe they could be effective for COVID-19.
A team, led by Aakriti Gupta, MD, MS, New York-Presbyterian Hospital and the Columbia University Irving Medical Center, assessed the use of antecedent statin using medication information available using electronic medical records for patients admitted to the hospital with COVID-19 between February 1 and May 12, 2020.
In the retrospective analysis, the investigators constructed a multivariable logistic regression model that enabled them to predict the propensity of receiving statins, adjusting for baseline sociodemographic and clinical characteristics, as well as outpatient medications. A total of 2626 patients were included in the study, 951 (36.2%) of which were antecedent statin users.
Overall, the patients who were prescribed statins were older with a median age of 70, compared to the non-statin group with a median age of 62 years old (P <0.001). There were also no significant differences found in sex (P = 0.06) or race and ethnicity (P = 0.12).
The investigators sought primary endpoints of in-hospital mortality within 30 days.
Of 1296 patients identified with an equal propensity score match, statin use was significantly linked to lower odds of the primary endpoint (OR, 0.47; 95% CI, 0.36-0.62; P <0.001).
In addition, patients using statins were more likely to have hypertension (74.0% vs. 43.3%), diabetes (55.8% vs. 26.1%), coronary artery disease (22.5% vs. 6.9%), heart failure (17.0% vs. 6.7%), and chronic kidney disease (22.0% vs. 9.6%) compared with patients not receiving statins (P < 0.001 for all).
The statin group also had higher rates of history of stroke/transient ischemic attack (13.9% vs. 5.6%) and atrial arrhythmias (11.0% vs. 5.6%) (P < 0.001 for both).
Patients on statins were significantly more likely to be prescribed ACEi (19.7% vs. 4.2%), angiotensin-receptor blockers (13.1% vs. 3.7%), P2Y12 inhibitors (11.9% vs. 1.1%), oral anticoagulants (20.3% vs. 12.3%), and beta-blockers (44.0% vs. 12.7%) as outpatients compared to the non-statin group (P < 0.001 for all).
In addition, 77% of the patients who were on antecedent statins and 8.6% of the patients not using antecedent statins received statins during hospitalization.
The Benefits of Statins
Patients on statins had significantly lower white blood cell count at baseline [7.6; 95% CI, 5.5–10.3) vs. 8.1; 95% CI, 5.8–11.6] and lower CRP levels [100.0; 95% CI, 46.2–168.5 vs. 120.7; 95% CI, 61.2–194.9; P < 0.01 for both), with no significant differences in high-sensitivity troponin T, D-dimer, ferritin, or ESR levels between the 2 groups.
Overall, in-hospital mortality occurred in 96 (14.8%) patients in the statin group, compared to 172 (26.5%) patients in the non-statin group (OR, 0.47; 95% CI, 0.36-0.62; P <0.001).
There were also no significant differences found in invasive mechanical ventilation, vasopressor use, renal replacement therapy, or length of stay between the 2 groups.
“We conclude that antecedent statin use in patients hospitalized with COVID-19 is associated with lower inpatient mortality,” the authors wrote. “Statin use was significantly associated with a reduction in the primary endpoint (in-hospital mortality within 30 days) in the overall cohort in univariate (OR 0.69, 95% CI 0.56-0.85) and multivariable-adjusted analysis (OR 0.49, 95% CI 0.38–0.63).”
How Statins Have Been Used
While in the past statins have been administered to lower serum cholesterol, their pleiotropic effects such as anti-inflammatory and antithrombotic properties, make them a viable candidate in treating COVID-19, in particular because the effects on lipid rafts in cellular membranes, the class of drugs could influence viral transmission and ineffectively, mitigating the impact of myocardial injuries and thrombotic events commonly linked to severe COVID-19 presentations.
Statins have also been studied in the past for the treatment of pneumonia and acute respiratory distress syndrome (ARDS).
The study, “Association between antecedent statin use and decreased mortality in hospitalized patients with COVID-19,” was published online in Nature Communications.