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COVID-19 induces a hyper-inflammatory state and due to their anti-inflammatory effect, statins might represent a useful treatment option.
Statins are the most widely prescribed drugs to lower cholesterol levels but also have several pleiotropic effects including anti-inflammatory and antithrombotic actions. Since endocytic entry of viral particles into cells is thought to be mediated through “lipid rafts”, i.e., areas of the cell membrane rich in cholesterol and other lipids, it is possible that any drug which depletes endogenous cholesterol (such as statins) might limit or minimise the extent of viral infection. Although evidence to date on the value of enteral simvastatin as a treatment in patient with in respiratory distress syndrome has been disappointing, subgroup analysis has revealed how those with a hyper-inflammatory state had improved survival with simvastatin compared to placebo. With statins potentially able to provide a protective effect against viral infection, a team from the New York-Presbyterian Hospital, New York, US, set out to examine whether antecedent prescription of these drugs in patients admitted to hospital with COVID-19, might have a positive effect on clinical outcomes. Undertaking a retrospective analysis using propensity score matching and logistic regression, the researchers investigated whether prior use affected the primary endpoint of in-hospital mortality after 30 days and use of invasive mechanical ventilation at 30 days as a secondary outcome.
Findings
From a total of 2626 hospitalised patients, 951 (36.2%) were prior users with a median age of 70 years with an equal gender distribution. In addition, statin users had a higher incidence of co-morbidities, in particular hypertension (74%), diabetes (55%) and coronary heart disease (22.5%) compared with non-statin patients. Mortality within 30 days occurred in 96 (14.8%) of those receiving statins compared to 172 (26.5%) in the non-statin group (odds ratio, OR = 0.47 95% CI 0.36 – 0.62, p < 0.001). Similarly, the second endpoint occurred in 18.6% vs 21.9% (users vs non-users). The authors speculated that one mechanism to account for the lower mortality among users was due to the lower mean levels of the inflammatory marker C-reactive protein (CRP) indicating a reduced hyper-inflammatory response. They called for randomised trials to evaluate the benefits of statin therapy in those affected by COVID-19.
Citation
Gupta A et al. Association between antecedent statin use and decreased mortality in hospitalised patients with COVID-19. Nat Commun 2021
