Highlights from

ACC 2021

American College of Cardiology Annual Congress 2021

Virtual 15-17 May 2021

Atorvastatin does not reduce mortality in COVID-19

Summary: Patients hospitalised with COVID-19 and given atorvastatin fared no better than patients who were given a placebo, with respect to reducing venous or arterial thrombosis, treatment with extracorporeal membrane oxygenation (ECMO), or all-cause mortality.1 There was no difference between the groups in terms of the main safety outcomes of clinically diagnosed myopathy or elevated liver enzymes.

Some patients with COVID-19 exhibit a dramatic immune response, resulting in increased thrombotic events and a hyperinflammatory state. The intensity of the immune response can lead to the development of acute respiratory distress syndrome (ARDS) and ultimately death. Statins are known to exhibit pleiotropic effects that include anti-inflammatory and anti-thrombotic effects. Previous studies have shown a beneficial effect of statins on hyper-inflammatory phenotypes of ARDS (but not hypo-inflammatory phenotypes). Furthermore, antecedent statin use has been associated with decreased mortality in COVID-19 hospitalised patients.

Dr Behnood Bikdeli (Brigham and Women's Hospital, US) and colleagues aimed to investigate whether statins could be of benefit in patients who are severely affected with COVID-19. The INSPIRATION trial (NCT04486508) randomised 605 patients who were critically ill with COVID-19 to receive either 20 mg of atorvastatin daily (n=303) or a placebo (n=302) over a 30-day follow-up period. Of the original 303 patients in the atorvastatin arm, 290 were included in the prespecified primary analysis; of the original 302 patients in the placebo arm, 297 were included in the prespecified primary analysis. The primary endpoint was a composite of 30-day venous or arterial thrombosis, treatment with ECMO, or all-cause mortality. In the atorvastatin arm, 95/290 (32.7%) achieved the primary endpoint, as compared with 108/297 (36.3%) in the placebo arm (HR 0.84; 95% CI 0.63-1.11; P=0.22). The investigators suggested that a smaller treatment effect cannot be excluded. They also identified the need for further research that explores the potential role of statins if administered sooner; that is, before the hyperinflammatory pathway is activated.

  1. Bikdeli B. Atorvastatin versus placebo in critically-ill patients with Covid-19: the Inspiration-S double blind randomized controlled trial. Abstract 409-16, ACC 2021 Scientific Session, 15-17 May 2021

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