Veterans Affairs Puget Sound Health Care System Seattle Division, Seattle, Washington, USA
Department of Medicine, University of Washington, Seattle, Washington, USA.
BMJ Open. 2022 Mar 18;12(3):e058363. doi: 10.1136/bmjopen-2021-058363.
To estimate associations of statin use with hospitalisation, intensive care unit (ICU) admission and mortality at 30 days among individuals with and without a positive test for SARS-CoV-2.
Retrospective cohort study.
US Veterans Health Administration (VHA).
All veterans receiving VHA healthcare with ≥1 positive nasal swab for SARS-CoV-2 between 1 March 2020 and 10 March 2021 (cases; n=231 154) and a comparator group of controls comprising all veterans who did not have a positive nasal swab for SARS-CoV-2 but who did have ≥1 clinical lab test performed during the same time period (n=4 570 252).
Associations of: (1) any statin use, (2) use of specific statins or (3) low-intensity/moderate-intensity versus high-intensity statin use at the time of positive nasal swab for SARS-CoV-2 (cases) or result of clinical lab test (controls) assessed from pharmacy records with hospitalisation, ICU admission and death at 30 days. We also examined whether associations differed between individuals with and without a positive test for SARS-CoV-2.
Among individuals who tested positive for SARS-CoV-2, statin use was associated with lower odds of death at 30 days (OR 0.81 (95% CI 0.77 to 0.85)) but not with hospitalisation or ICU admission. Associations were similar comparing use of each specific statin to no statin. Compared with low-/moderate intensity statin use, high-intensity statin use was not associated with lower odds of ICU admission or death. Over the same period, associations of statin use with 30-day outcomes were significantly stronger among individuals without a positive test for SARS-CoV-2: hospitalisation OR 0.79 (95% CI 0.77 to 0.80), ICU admission OR 0.86 (95% CI 0.81 to 0.90) and death 0.60 (95% CI 0.58 to 0.62; p for interaction all <0.001).
Associations of statin use with lower adverse 30-day outcomes are weaker among individuals who tested positive for SARS-CoV-2 compared with individuals without a positive test, indicating that statins do not exert SARS-CoV-2 specific effects.
评估在新冠病毒检测呈阳性和阴性的个体中，使用他汀类药物与 30 天住院、重症监护病房（ICU）入院和死亡率之间的关联。
回顾性队列研究。
美国退伍军人医疗保健系统（VHA）。
所有在 2020 年 3 月 1 日至 2021 年 3 月 10 日期间接受 VHA 医疗保健且至少有一次新冠病毒鼻拭子检测呈阳性的退伍军人（病例组；n=231154），以及一组对照组，由在同一时期内没有新冠病毒鼻拭子检测呈阳性但至少进行过一次临床实验室检测的所有退伍军人组成（n=4570252）。
从药房记录中评估（1）任何他汀类药物的使用、（2）使用特定的他汀类药物或（3）在新冠病毒鼻拭子检测呈阳性（病例）或临床实验室检测结果呈阳性（对照组）时使用低强度/中等强度与高强度他汀类药物与 30 天住院、ICU 入院和死亡之间的关联。我们还检查了这些关联在新冠病毒检测呈阳性和阴性的个体之间是否存在差异。
在新冠病毒检测呈阳性的个体中，他汀类药物的使用与 30 天死亡率降低相关（OR 0.81（95%CI 0.77 至 0.85）），但与住院或 ICU 入院无关。与不使用他汀类药物相比，使用每种特定的他汀类药物与死亡率降低的关联相似。与低/中度强度他汀类药物相比，高强度他汀类药物的使用与 ICU 入院或死亡的低风险无关。在同一时期内，他汀类药物的使用与 30 天结局之间的关联在新冠病毒检测呈阴性的个体中明显更强：住院 OR 0.79（95%CI 0.77 至 0.80），ICU 入院 OR 0.86（95%CI 0.81 至 0.90）和死亡 0.60（95%CI 0.58 至 0.62；p 交互作用均<0.001）。
与新冠病毒检测阴性的个体相比，新冠病毒检测呈阳性的个体使用他汀类药物与较低的不良 30 天结局之间的关联较弱，表明他汀类药物不会产生新冠病毒特异性影响。
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