Statin Therapy May Be Associated with Reduced Mortality Risk of Sepsis Patients: A Retrospective Study from the MIMIC-IV Database

BackgroundIt is controversial whether statin therapy is beneficial for sepsis patients. A large retrospective cohort study was conducted to evaluate the association between statin therapy and mortality in sepsis patients.MethodsAdult (≥18 years) sepsis patients were enrolled and divided into two groups: the statin group and the no-statin group. Data including demographic features, vital signs, laboratory tests, and comorbidities from MIMIC-IV v1.0 were extracted. Delirium was assessed via the Confusion Assessment Method for the ICU (CAM-ICU). Ninety-day mortality, 28-day mortality and the incidence of delirium after statin therapy were evaluated using multivariable logistic analysis, the PSM model and subgroup analysis based on univariate analysis. ResultsIn univariate analysis and multivariable logistic analysis, statin therapy showed a significant association with both reduced 28-day and 90-day mortality (90-day mortality: OR 0.58, 95% CI: 0.46-0.72, p<0.001; 28-day mortality: OR 0.47, 95% CI: 0.37-0.60, p<0.001), while no relationship was found between statin therapy and delirium (OR 0.92, 95% CI: 0.49-1.72, p=0.787). In further PSM model and subgroup analyses or sensitivity analysis, consistent results were shown. ConclusionStatin therapy is significantly associated with 28-day and 90-day mortality without decrease in the incidence of delirium.

Low-Dose Statins Improve Prognosis of Patients with Ischaemic Stroke Undergoing Intra-Arterial Thrombectomy: A Prospective Cohort Study

Background: High-dose statins are recommended as preventive drugs in guidelines for patients with ischaemic stroke undergoing thrombectomy. Not only in clinical practice but also based on large-scale studies, low-dose statins have been widely used and demonstrated to be efficient in Asian populations. However, it remains unknown whether low-dose statin is related to the prognosis of patients with thrombectomy. Can low-dose statins reduce the risk of bleeding at the same time?Methods: We prospectively collected data from patients with acute ischaemic stroke undergoing intra-arterial thrombectomy. Efficacy outcomes were National Institutes of Health Stroke Scale (NIHSS) score improvement at 7 days after admission and a favourable functional outcome (FFO) at 90 days. Safety outcomes were rates of in-hospital haemorrhage events and death within 2 years. Results: We included 256 patients in this study. Compared with the control group, the low-dose statin group had a higher NIHSS improvement rate at 7 days, a higher FFO rate at 90 days and a lower death rate within 2 years. The low-dose statin group had a lower percentage of gastrointestinal haemorrhage. Statin use was significantly related to an improved NIHSS score (p=0.028, OR=1.773) at 7 days and FFO (P<0.001, OR=2.962) at 90 days and to lower death rates (P=0.025, or=0.554) within 2 years.Conclusion: In Asian acute ischaemic stroke patients with intra-arterial thrombectomy, low-dose statin use was significantly related to NIHSS improvement at 7 days, FFO at 90 days and decreased death rates within 2 years.

Statin Use and In-hospital Mortality in Patients with COVID-19 and Coronary Heart Disease

The worsening progress of coronavirus disease 2019 (COVID-19) is attributed to the proinflammatory state, leading to increased mortality. Statin works with its anti-inflammatory effects and may attenuate the worsening of COVID-19. COVID-19 patients were retrospectively enrolled from two academic hospitals in Wuhan, China, from 01/26/2020 to 03/26/2020. Adjusted in-hospital mortality was compared between the statin and the non-statin group by CHD status using multivariable Cox regression model after propensity score matching. Our study included 3133 COVID-19 patients (median age: 62y, female: 49.8%), and 404 (12.9%) received statin. Compared with the non-statin group, the statin group was older, more likely to have comorbidities but with a lower level of inflammatory markers. The Statin group also had a lower adjusted mortality risk (6.44% vs. 10.88%; adjusted hazard ratio [HR] 0.47; 95% CI, 0.29–0.77). Subgroup analysis of CHD patients showed a similar result. Propensity score matching showed an overall 87% (HR, 0.13; 95% CI, 0.05–0.36) lower risk of in-hospital mortality for statin users than nonusers. Such survival benefit of statin was obvious both among CHD and non-CHD patients (HR = 0.30 [0.09–0.98]; HR = 0.23 [0.1–0.49], respectively). Statin use was associated with reduced in-hospital mortality in COVID-19. The benefit of statin was both prominent among CHD and non-CHD patients. These findings may further reemphasize the continuation of statins in patients with CHD during the COVID-19 era.

Statin Use is Associated With The Reduction in Hepatocellular Carcinoma Recurrence After Liver Surgery

Background Hepatocellular carcinoma (HCC) is the sixth most common form of cancer worldwide. Although surgical treatments have an acceptable cure rate, tumor recurrence is still a challenging issue. In this meta-analysis, we investigated whether statins prevent HCC recurrence following liver surgery. Methods PubMed, Web of Science, EMBASE and Cochrane Central were searched. The Outcome of interest was the HCC recurrence after hepatic surgery. Pooled estimates were represented as hazard ratios (HRs) and odds ratios (ORs) using a random-effects model. Summary effect measures are presented together with their corresponding 95% confidence intervals (CI). The certainty of evidence was evaluated using the Grades of Research, Assessment, Development and Evaluation (GRADE) approach. Results The literature search retrieved 1,362 studies excluding duplicates. Nine retrospective studies including 44,219 patients (2,243 in the statin group and 41,976 in the non-statin group) were included in the qualitative analysis. Patients who received statins had a lower rate of recurrence after liver surgery (HR: 0.41; 95% CI: 0.31– 0.54; p <0.001). Moreover, Statins decreased the recurrence one year after surgery (OR: 0.27; 95% CI: 0.16–0.47; P < 0.001), three years after surgery (OR: 0.22; 95% CI: 0.15–0.33; P < 0.001), and five years after surgery (OR: 0.28; 95% CI: 0.19–0.42; P < 0.001). The certainty of evidence for the outcomes was moderate. Conclusion Statins increase the disease-free survival of patients with HCC after liver surgery. These drugs seem to have chemoprevention effects that decrease the probability of HCC recurrence after liver transplantation or liver resection.

PERBANDINGAN BERAS RAGI MERAH DAN SIMVASTATIN DALAM MENURUNKAN PROFIL LIPID : EVIDENCE-BASED CASE REPORT

Background: Dyslipidemia is major risk factor of non-communicable disease and nutraceutical like red yeast rice (RYR) may be helpful as alternative to lowering lipid profile in dyslipidemia. Research objectives: This literature is to critically analyze the comparison RYR and simvastatin in lowering lipid profile. Methods: A search for relevant literatures in PubMed, Scopus, Cochrane, and Science Direct was conducted. We assessing the relevancy and eligibility of the literatures. Three literatures were selected and critically appraised. Results: There were no significant different between RYR and statin group for triglyceride (TG), high-density lipoprotein-cholesterol (HDL-C), especially the total cholesterol (TC) and the low-density lipoprotein-cholesterol (LDL-C) level. Red yeast rice (RYR) show less fatigue side effect than statin. Conclusions: Nutraceutical like RYR can be an alternative to lowering lipid profile especially TC level and LDL-C level and solution for patients who experience statin-associated myalgia. Keywords: red yeast rice, monacolin K, simvastatin, lipid profile

Statin Use Can Attenuate the Decline in Left Ventricular Ejection Fraction and the Incidence of Cardiomyopathy in Cardiotoxic Chemotherapy Recipients: A Systematic Review and Meta-Analysis

There is insufficient evidence about the cardioprotective effects of statins against chemotherapy-induced cardiomyopathy. The MEDLINE and EMBASE databases were searched from inception to March 2021 for studies that reported the mean left ventricular ejection fraction (LVEF) before and after chemotherapy and the incidence of chemotherapy-induced cardiotoxicity in patients who received concurrent statin therapy and those who received chemotherapy alone. A random effects meta-analysis was performed to obtain the pooled weighted mean difference (WMD) and the 95% confidence interval (CI) for the mean final LVEF and the mean LVEF change, and the pooled odds ratio (OR) and the 95% CI of the incidence of chemotherapy-induced cardiomyopathy. Seven studies with 3042 patients were included in this meta-analysis (statin group: 1382 patients received concurrent statin with chemotherapy; control group: 1660 patients received chemotherapy alone). Patients in the control group had a more significant decline in LVEF (WMD = −6.08%, 95% CI: −8.55 to −3.61, p < 0.001) compared to those in the statin group. Additionally, the statin group had a significantly lower incidence of chemotherapy-induced cardiomyopathy compared to the control group (OR = 0.41, 95% CI = 0.28–0.60, p < 0.001). Consequently, our study showed a significant reduction in the incidence of chemotherapy-induced cardiomyopathy and the degree of LVEF decline in patients in the statin group compared to those in the control group.

Statins and clinical outcomes in hospitalized COVID-19 patients with and without Diabetes Mellitus: a retrospective cohort study with propensity score matching

Background The pleiotropic effects of statins may reduce the severity of COVID-19 disease. This study aims to determine the association between inpatient statin use and severe disease outcomes among hospitalized COVID-19 patients, especially those with Diabetes Mellitus (DM). Research design and methods A retrospective cohort study on hospitalized patients with confirmed COVID-19 diagnosis. The primary outcome was mortality during hospitalization. Patients were classified into statin and non-statin groups based on the administration of statins during hospitalization. Analysis included multivariable regression analysis adjusting for confounders and propensity score matching to achieve a 1:1 balanced cohort. Subgroup analyses based on presence of DM were conducted. Results In the cohort of 922 patients, 413 had a history of DM. About 27.1% patients (n = 250) in the total cohort (TC) and 32.9% patients (n = 136) in DM cohort received inpatient statins. Atorvastatin (n = 205, 82%) was the most commonly prescribed statin medication in TC. On multivariable analysis in TC, inpatient statin group had reduced mortality compared to the non-statin group (OR, 0.61; 95% CI, 0.42–0.90; p = 0.01). DM modified this association between inpatient statins and mortality. Patients with DM who received inpatient statins had reduced mortality (OR, 0.35; 95% CI, 0.21–0.61; p < 0.001). However, no such association was noted among patients without DM (OR, 1.21; 95% CI, 0.67–2.17; p = 0.52). These results were further validated using propensity score matching. Conclusions Inpatient statin use was associated with significant reduction in mortality among COVID-19 patients especially those with DM. These findings support the pursuit of randomized clinical trials and inpatient statin use appears safe among COVID-19 patients.

Preventive Effect of Shenduning Prescription Combined with Hydration Therapy on Contrast Induced Nephronpathy after Elective Percutaneous Coronary Intervention

Objective — To explore the preventive effect of Shenduning prescription combined with hydration therapy on contrast induced nephronpathy (CIN) after elective percutaneous coronary intervention. Methods — 159 patients undergoing selective coronary intervention were divided into simple hydration group, intensive statin group and Shenduning prescription group randomly, with 53 cases in each group. The simple hydration group received conventional drugs for coronary heart disease and preoperative routine hydration therapy. The intensive statin group received intensive treatment with atorvastatin calcium tablets on the basis of the simple hydration group, and the Shenduning prescription group received Shenduning prescription treatment on the basis of the hydration group. Serum creatinine (Scr), malondialdehyde (MDA), superoxide dismutase (SOD) and glomerular filtration rate (eGFR) were detected by blood samples at 24h before and after operation, as well as 72h after operation respectively. The primary endpoint event was the occurrence of CI-AKI. Results — The Scr level of the intensive statin group and the Shenduning prescription group was significantly lower than that of the simple hydration group, while the eGFR level was significantly higher than that of the simple hydration group, which is of statistical significance (P<0.05). The incidence of CI-AKI was 15.1% in simple hydration group, 5.7% in intensive statin group and 3.8% in Shenduning prescription group respectively after operation (χ2 = 5.194, P=0.075), of which there was significant statistical difference between simple hydration group and Shenduning prescription group (χ2 = 3.975, P=0.046). After 72h of the operation, MDA level in Shenduning prescription group was significantly lower than that in simple hydration group and intensive statin group, while its SOD level was significantly higher than that in simple hydration group and intensive statin group, which is of statistical significance (P<0.05). The proportion of abnormal liver function in intensive statin group and the Shenduning prescription group was 13.1% and 3.8%, respectively, and the difference was statistically significant (χ2 = 4.867, P=0.027). Conclusion — The combination treatment of Shenduning prescription with hydration therapy may protect the patient’s renal function after elective coronary interventional therapy, while reducing the incidence of CIN and the oxidative stress reaction caused by contrast agent, thus effectively reducing adverse reactions.

Low dose statins improve prognosis of ischemic stroke patients with intravenous thrombolysis

Background For acute ischaemic stroke patients, it is uncertain whether intravenous thrombolysis combined with statins might increase the therapeutic effect. Additionally, using high-intensity statins after thrombolysis may increase the risk of bleeding in patients. Asian stroke patients often take low-dose statins. It is speculated that reducing the dose of statins may improve the risk of bleeding. Methods Data from consecutive acute ischaemic stroke patients with intravenous thrombolysis were prospectively collected. Efficacy outcomes included NIHSS (National Institutes of Health Stroke Scale) score improvement at 7 days after admission and mRS (Modified Rankin Scale) improvement at 90 days. Safety outcomes included haemorrhage events (intracerebral haemorrhage and gastrointestinal haemorrhage) in the hospital and death events within 2 years. Results The study finally included 215 patients. The statin group had a higher percentage of NIHSS improvement at 7 days (p < 0.001) and a higher percentage of a favourable functional outcome (FFO, mRS < = 2) (p < 0.001) at 90 days. The statin group had a lower percentage of intracerebral haemorrhage (p < 0.001) and gastrointestinal haemorrhage (p = 0.003) in the hospital and a lower percentage of death events (p < 0.001) within 2 years. Logistic regression indicated that statin use was significantly related to NIHSS improvement (OR = 4.697, p < 0.001), a lower percentage of intracerebral haemorrhage (OR = 0.372, p = 0.049) and gastrointestinal haemorrhage (OR = 0.023, p = 0.016), and a lower percentage of death events (OR = 0.072, p < 0.001). Conclusion For acute ischaemic stroke patients after intravenous thrombolysis, the use of low-dose statins was related to NIHSS improvement at 7 days and inversely related to haemorrhage events in the hospital and death events within 2 years, especially for moderate stroke or noncardioembolic stroke patients.

Do statins reduce the rate of revision surgery after chronic subdural hematoma drain?

Background With chronic subdural hematoma (CSDH), surgery is the therapeutic mainstay for large or symptomatic cases. Statins are reported to be effective as the primary therapy of CSDH to obviate the need for surgery. However, the effect of statins on the postoperative course of CSDH is largely unclear. We therefore sought to determine whether statins reduce the rate of repeat surgery after CSDH drain. Methods We performed an analysis of all patients who underwent surgery for CSDH at our institution between 2012 and 2018. The patients were separated into those who received statins as part of their previous medication (statin group) and those who did not (control group). The medical records were reviewed for repeat surgeries and complications. Additionally, patients or their relatives were contacted via phone to obtain missing data and inquire about possible repeat surgeries at other institutions. Results We identified 407 patients who received CSDH evacuation via burr hole craniotomy. In total, 123 patients were treated with statins as part of their daily medication. Repeat surgery was performed in 26 patients in the statin group (21.1%) and 57 patients in the non-statin group (20.1%, p = 0.81). Upon multivariate logistic regression analysis, neither of the variables statins, age, antithrombotic medication, Charlson comorbidity index, or Markwalder grading score yielded a statistically significant effect upon the revision rate. Conclusions We found no evidence for the protective effect of statins in patients who underwent surgery for CSDH. We thus conclude that statin therapy is not warranted for CSDH perioperatively.