Purpose

COVID-19 is characterized by dysfunctional immune responses and metabolic derangements, which in some, lead to multi-organ failure and death. Statins are foundational lipid-lowering therapeutics for cardiovascular disease and also possess beneficial immune-modulating properties. Because of these immune-modulating properties, some have suggested their use in COVID-19. We sought to investigate the association between statin use and mortality in patients hospitalized with COVID-19.

Methods

Five thousand three hundred seventy-five COVID-19 patients admitted to Mount Sinai Health System hospitals in New York between February 27, 2020, and December 3, 2020, were included in this analysis. Statin use was classified as either non-user, low-to-moderate-intensity user, or high-intensity user. Multivariate Cox proportional hazards models were used to evaluate in-hospital mortality rate. Considered covariates were age, sex, race, and comorbidities.

Results

Compared to non-statin users, both low-to-moderate-intensity (adjusted hazard ratio; aHR 0.62, 95% confidential intervals; CI 0.51–0.76) and high-intensity statin users (aHR 0.53, 95% CI 0.43–0.65) had a reduced risk of death. Subgroup analysis of 723 coronary artery disease patients showed decreased mortality among high-intensity statin users compared to non-users (aHR 0.51, 95% CI 0.36–0.71).

Conclusions

Statin use in patients hospitalized with COVID-19 was associated with a reduced in-hospital mortality. The protective effect of statin was greater in those with coronary artery disease. These data support continued use of statin therapy in hospitalized patients with COVID-19. Clinical trials are needed to prospectively determine if statin use is effective in lowering the mortality in COVID-19 and other viral infections.

中文翻译：

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他汀类药物治疗对 COVID-19 住院患者的疗效

目的

COVID-19 的特点是免疫反应功能失调和代谢紊乱，在某些情况下，这会导致多器官衰竭和死亡。他汀类药物是心血管疾病的基础降脂疗法，还具有有益的免疫调节特性。由于这些免疫调节特性，一些人建议将它们用于 COVID-19。我们试图调查他汀类药物的使用与 COVID-19 住院患者死亡率之间的关系。

方法

2020 年 2 月 27 日至 2020 年 12 月 3 日期间纽约西奈山卫生系统医院收治的 5375 名 COVID-19 患者被纳入该分析。他汀类药物的使用被分类为非使用者、中低强度使用者或高强度使用者。多变量 Cox 比例风险模型用于评估院内死亡率。考虑的协变量是年龄、性别、种族和合并症。

结果

与非他汀类药物使用者相比，低至中等强度（调整后的风险比；aHR 0.62，95% 置信区间；CI 0.51–0.76）和高强度他汀类药物使用者（aHR 0.53，95% CI 0.43–0.65）降低了死亡风险。对 723 名冠状动脉疾病患者的亚组分析显示，与非使用者相比，高强度他汀类药物使用者的死亡率降低（aHR 0.51，95% CI 0.36–0.71）。

结论

COVID-19 住院患者使用他汀类药物可降低院内死亡率。他汀类药物对冠心病患者的保护作用更大。这些数据支持在住院的 COVID-19 患者中继续使用他汀类药物治疗。需要进行临床试验来前瞻性地确定他汀类药物的使用是否能有效降低 COVID-19 和其他病毒感染的死亡率。