Choosing statins: a review to guide clinical practice

Association between statin use and 30-day mortality among patients with sepsis-associated encephalopathy: a retrospective cohort study

Aim

Sepsis-associated encephalopathy (SAE) is a common and serious complication of sepsis with poor prognosis. Statin was used in SAE patients, whereas its effects on these patients remain unknown. This study is aimed at investigating the impact of statins on the 30-day mortality of patients with SAE.

Methods

In this retrospective cohort study, data from SAE patients were extracted from the Medical Information Mart for Intensive Care IV (MIMIC-IV). Statins include atorvastatin, pravastatin, rosuvastatin, and simvastatin. The outcome was 30-day mortality of SAE patients starting 24 h after the first intensive care unit (ICU) admission and at the first time after hospitalization. Potential covariates (sociodemographic characteristics, vital signs, score indexes, laboratory parameters, comorbidities, and treatment intervention methods) were selected using univariate Cox proportional hazard analysis. Associations between statin use and statin type and 30-day mortality were explored using univariate and multivariate Cox proportional hazard models with hazard ratios (HRs) and 95% confidence intervals (CIs). Associations were further explored in different age groups, sex, sequential organ failure assessment (SOFA), simplified acute physiology score II (SAPS II), and systemic inflammatory response syndrome (SIRS) populations.

Results

A total of 2,729 SAE patients were included in the study, and 786 (28.8%) died within 30 days. Statin use was associated with lower odds of 30-day mortality (HR = 0.77, 95%CI: 0.66-0.90) in all SAE patients. Patients who took simvastatin treatments were associated with lower odds of 30-day mortality (HR = 0.58, 95%CI: 0.43-0.78). Rosuvastatin treatments had a higher 30-day mortality risk (HR = 1.88, 95%CI: 1.29-2.75). Statin use was also associated with lower 30-day mortality among patients of different ages, sex, sequential organ failure assessment (SOFA), SAPS II, and SIRS.

Conclusion

Patients who were treated with simvastatin were associated with lower odds of 30-day mortality in SAE patients. Caution should be paid to statin use in SAE patients, particularly in patients treated with rosuvastatin or pravastatin.

Atorvastatin lowers breast cancer risk by reversing an early tumorigenic signature

Breast cancer remains a significant health challenge with complex molecular mechanisms. While many studies have explored genetic markers in breast carcinogenesis, few have studied the potential impact of pharmacological interventions such as Atorvastatin on its genetic landscape. This study aimed to elucidate the molecular distinctions between normal and tumor-adjacent tissues in breast cancer and to investigate the potential protective role of atorvastatin, primarily known for its lipid-lowering effects, against breast cancer. Searching the Gene Expression Omnibus database identified two datasets, GSE9574 and GSE20437, comparing normal breast tissues with tumor-adjacent samples, which were merged, and one dataset, GSE63427, comparing paired pre- and post-treated patients with atorvastatin. Post-ComBat application showed merged datasets' consistency, revealing 116 DEGs between normal and tumor-adjacent tissues. Although initial GSE63427 data analysis suggested a minimal impact of atorvastatin, 105 DEGs post-treatment were discovered. Thirteen genes emerged as key players, both affected by Atorvastatin and dysregulated in tumor-adjacent tissues. Pathway analysis spotlighted the significance of these genes in processes like inflammation, oxidative stress, apoptosis, and cell cycle control. Moreover, there was a noticeable interaction between these genes and the immunological microenvironment in tumor-adjacent tissues, with Atorvastatin potentially altering the suppressive immune landscape to favor anti-tumor immunity. Survival analysis further highlighted the prognostic potential of the 13-gene panel, with 12 genes associated with improved survival outcomes. The 13-gene signature offers promising insights into breast cancer's molecular mechanisms and atorvastatin's potential therapeutic role. The preliminary findings advocate for an in-depth exploration of atorvastatin's impact on.

Fluvastatin: A Choice for COVID-19-associated Mucormycosis Management

SARS-CoV-2 invades the respiratory tract epithelium and can result in systemic inflammation prior to an infection caused by either bacteria or fungus. COVID-19- associated mucormycosis (CAM) is a serious condition that can occur during the time of the disease due to increased administration of corticosteroids. Various studies have suggested that statins may improve clinical outcomes in COVID-19 patients. According to several preclinical reports, fluvastatin was shown to exert direct and indirect synergistic antifungal activity. Thus, fluvastatin could be considered a potential antifungal agent when no other option is available. Furthermore, in comparison with other statins, fluvastatin exhibits the fewest drug/drug interactions with anti-Mucorales azoles (e.g., isavuconazole and posaconazole), as well as with medicines that are used in solid organ transplant recipients (e.g., cyclosporine) and HIV-positive individuals (e.g., ritonavir); two groups of patients that have a higher risk of infection with Mucorales fungi following a SARSCoV- 2 infection.

Rosuvastatin treatment alone cannot alleviate lupus in murine model: a pilot study

Objective

Systemic lupus erythematosus (SLE) is an autoimmune disease, characterized by the production of autoantibodies and high cholesterol levels. HMG-CoA (3-hydroxy-3-methylglutaryl-coenzyme A) reductase inhibitors have exhibited anti-inflammatory effects in several clinical trials. We conducted this study to evaluate the effect of rosuvastatin on inflammatory responses in lupus-prone mice.

Methods

MRL/lpr mice were intraperitoneally injected with rosuvastatin (10 mg/kg, n=4) or vehicle (2% dimethyl sulfoxide, n=4) five times a week from 13 to 17 weeks of age. The serum levels of low-density lipoprotein (LDL) cholesterol and autoantibodies were measured, as well as the urine levels of albumin. Renal tissues were stained for histopathological analysis. Concentrations of key inflammatory cytokines were measured in the serum, and messenger RNA (mRNA) levels in target organs (kidney, spleen, and lymph nodes) were evaluated.

Results

Rosuvastatin treatment significantly decreased serum LDL cholesterol concentration in MRL/lpr mice. However, the clinical manifestations and autoantibody titres did not improve with rosuvastatin treatment. In addition, serum inflammatory cytokines and proteinuria did not change. Histopathological analysis of the kidneys revealed no improvement. When assessing the expression of mRNA, treatment with rosuvastatin decreased tumor necrosis alpha and interleukin-17 concentration in spleen and kidney tissue and in the kidneys and lymph nodes of MRL/lpr mice, respectively.

Conclusion

Although it can decrease inflammatory cytokines in the lymphoid organs and kidneys of MRL/lpr mice, treatment with rosuvastatin is insufficient to alleviate SLE.

Imaging subclinical coronary atherosclerosis to guide lipid management, are we there yet?

Atherosclerotic cardiovascular disease risk (ASCVD) is an ongoing epidemic, and lipid abnormalities are its primordial cause. Most individuals suffering a first ASCVD event are previously asymptomatic and often do not receive preventative therapies. The cornerstone of primary prevention has been the identification of individuals at risk through risk calculators based on clinical and laboratory traditional risk factors plus risk enhancers. However, it is well accepted that a clinical risk calculator misclassifies a significant proportion of individuals leading to the prescription of a lipid-lowering medication with very little yield or a missed opportunity for lipid-lowering agents with a potentially preventable event. The development of coronary artery calcium scoring (CAC) and CT coronary angiography (CCTA) provide complementary tools to directly visualize coronary plaque and other risk-modifying imaging components that can potentially provide individualized lipid management. Understanding patient selection for CAC or potentially CCTA and the risk implications of the different parameters provided, such as CAC score, coronary stenosis, plaque characteristics and burden, epicardial adipose tissue, and pericoronary adipose tissue, have grown more complex as technologies evolve. These parameters directly affect the shared decision with patients to start or withhold lipid-lowering therapies, to adjust statin intensity or LDL cholesterol goals. Emerging lipid lowering studies with non-invasive imaging as a guide to patient selection and treatment efficacy, plus the evolution of lipid lowering therapies from statins to a diverse armament of newer high-cost agents have pushed these two fields forward with a complex interaction. This review will discuss existing risk estimators, and non-invasive imaging techniques for subclinical coronary atherosclerosis, traditionally studied using CAC and more recently CCTA with qualitative and quantitative measurements. We will also explore the current data, gaps of knowledge and future directions on the use of these techniques in the risk-stratification and guidance of lipid management.

Use of Lipid-Lowering Drugs and Associated Outcomes According to Health State Profiles in Hospitalized Older Patients

Objective

To assess how lipid-lowering drugs (LLDs) are administered in the hospitalized patients aged 65 and older and their association with clinical outcomes according to their health-related profiles.

Design

This is a retrospective study based on data from REPOSI (REgistro POliterapie SIMI - Italian Society of Internal Medicine) register, an Italian network of internal medicine hospital wards.

Setting and Participants

A total of 4642 patients with a mean age of 79 years enrolled between 2010 and 2018.

Methods

Socio-demographic characteristics, functional abilities, cognitive skills, laboratory parameters and comorbidities were used to investigate the health state profiles by using multiple correspondence analysis and clustering. Logistic regression was used to assess whether LLD prescription was associated with patients' health state profiles and with short-term mortality.

Results

Four clusters of patients were identified according to their health state: two of them (Cluster III and IV) were the epitome of frailty conditions with poor short-term outcomes, whereas the others included healthier patients. The average prevalence of LLD use was 27.6%. The lowest prevalence was found among the healthier patients in Cluster I and among the oldest frail patients with severe functional and cognitive impairment in Cluster IV. The highest prevalence was among multimorbid patients in Cluster III (OR=4.50, 95% CI=3.76-5.38) characterized by a high cardiovascular risk. Being prescribed with LLDs was associated with a lower 3-month mortality, even after adjusting for cluster assignment (OR=0.59; 95% CI = 0.44-0.80).

Conclusion

The prevalence of LLD prescription was low and in overall agreement with guideline recommendations and with respect to patients' health state profiles.