Clinical question: Does discontinuation of atorvastatin in those hospitalized with COVID-19 change the risk of mortality and ventilation?
Dr. Clark
Background: Statins are ubiquitous. Statins may be beneficial in COVID-19 given their intrinsic anti-inflammatory properties and ability to upregulate the angiotensin-converting enzyme-2 receptor. Some observational studies have linked statin use to lower mortality in COVID-19, and current guidelines recommend its continuation in those with COVID-19.
Study design: Retrospective chart analysis
Setting: Electronic health records associated with HCA Healthcare (Nashville, Tenn.) facilities across 21 U.S. states
Synopsis: Medication administration data was collected for all patients admitted with a laboratory-confirmed diagnosis of COVID-19 from 2015 to 2019. Patients (n = 146,413) were divided into three groups for analysis: continuation of statin group; discontinuation of statin group; and no statin group. Logistic regression analysis was performed to assess the associations between atorvastatin use, mortality, and mechanical ventilation.
In comparison to discontinuation of statin therapy, those who received continuous statin therapy had a reported, significant 35% reduction in odds of mortality. Compared to those with no known prior statin use, patients with continuous use had a reported, significant 28% reduction in odds of mortality. Compared to no known statin use, those with discontinuation had no change in odds of mortality (OR: 1.01). In the secondary analysis, the odds of ventilation were similarly decreased in the continuous group compared to the discontinuation group.
Potential confounding is a significant limitation. For example, clinical factors (such as the severity of illness) likely contributed to the discontinuation of statins on admission. A prospective, randomized, controlled trial would be helpful.
Bottom line: Continuation of statin therapy does not appear to be harmful, and discontinuation may be associated with poorer outcomes. Providers should follow guideline recommendations to continue statin therapy in those hospitalized with COVID-19.
Citation: Andrews L, et al. Discontinuation of atorvastatin use in hospital is associated with increased risk of mortality in COVID-19 patients. J Hosp Med. 2022;17:169- 175.
Dr. Clark is an internal medicine chief resident at Maine Medical Center, Portland, Maine who’s pursuing a career in hospital medicine.