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A study on statin use in patients hospitalized with COVID-19 — as well as research into safety concerns and upcoming guidance changes — resulted in this week's top trending clinical topic.
In encouraging news, statins were again linked to lower COVID-19 mortality (see Infographic below). The findings come from an analysis of data from the American Heart Association's COVID-19 Cardiovascular Disease Registry on more than 10,000 patients hospitalized with COVID-19 at 104 hospitals across the United States and were published in PLOS One . Most patients in the study (71%) had either cardiovascular disease, hypertension, or both. Prior to admission, 42% used statins, with 7% taking statins alone and 35% taking statins plus antihypertensives.
Investigators have reiterated that these findings do not suggest that individuals who are not currently taking statins should begin doing so to lower their risk for COVID mortality; however, experts do suggest that those with indications for the drugs should see this as another reason to start taking them if they are not already doing so. The theory is not necessarily that statins have direct anti-COVID effects but that they are probably helping to stabilize coronary disease. This means that patients are less likely to die from stroke or myocardial infarction, allowing more time and strength for COVID-19 recovery.
Another reassuring study found that statins are associated with a low risk for adverse effects in patients without a history of heart disease. The systemic review and meta-analysis found a slightly increased risk for self-reported muscle symptoms but no increased risk for clinically confirmed muscle disorders. Small risks for liver dysfunction, renal insufficiency, and eye conditions were also identified. Still, the authors acknowledge that the absolute benefits of statins are smaller in primary prevention than among patients with existing cardiovascular disease; thus, the benefit-to-harm ratio of their use may be less favorable in those without such disease.
Associations between statin use and dementia have also been an ongoing concern. Thus far, evidence has not conclusively demonstrated whether the drugs are beneficial, harmful, or have no effect on dementia risk. A recent conference presentation at the Society of Nuclear Medicine and Molecular Imaging Annual Meeting detailed the use of PET scans to identify differences in brain metabolism between statin users and others. The findings indicated that patients with mild cognitive impairment doubled their risk of developing dementia when taking lipophilic statins. However, Christopher Labos, MD, CM, MSc, recommends caution in interpreting those results, especially because the study used surrogate endpoints. Overall, Labos says he remains unworried about dementia risk posed by statins.
In regard to guidance for statin use, the US Food and Drug Administration is planning to update the blanket contraindication in all pregnant patients. In a recent announcement, the agency said that the change will indicate to physicians and patients that statin use in women with unrecognized pregnancy is unlikely to be harmful. The revision should emphasize for clinicians "that statins are safe to prescribe in patients who can become pregnant and help them reassure patients with unintended statin exposure in early pregnancy," the FDA explained. However, the FDA does suggest that statin therapy should be discontinued in most pregnant patients.
From these impending changes in recommendations for use to positive results from several high-profile studies, key news about statins resulted in this week's top trending clinical topic.
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Cite this: Ryan Syrek. Trending Clinical Topic: Statins - Medscape - Aug 13, 2021.