Statins not protective against dengue in infected patients with hyperlipidaemia

Statins appear to confer no benefit for dengue severity in patients with hyperlipidaemia, according to a Singapore study.

Specifically, use of the lipid-lowering medication upon hospital admission does not reduce dengue severity in infected hyperlipidaemia patients, the investigators said. “However, prior use of statins is not a risk factor for increased liver inflammation and supports the safety of continuing statins in patients with dengue.”

The study population included 257 dengue patients (mean age 61.3 years; 51.0 percent female) with a history of hyperlipidaemia, among whom 191 (74.3 percent) were statin users and 66 (25.7 percent) were nonusers. Medications used included simvastatin (69.1 percent), lovastatin (17.3 percent), atorvastatin (8.4 percent), rosuvastatin (4.2 percent) and pravastatin (1.0 percent).

Compared with nonusers, statin users were significantly more likely to be overweight or obese, have a history of hypertension and chronic liver disease. Moreover, users were more likely to develop tachycardia and fluid accumulation and severe plasma leakage.

Multivariate Poisson regression analysis showed no association between statin use and reduced risk of both dengue haemorrhagic fever/shock syndrome (adjusted risk ratio [aRR], 0.66; 95 percent CI, 0.41–1.08; p=0.10) and severe dengue (aRR, 1.43; 0.84–2.43; p=0.19). [Sci Rep 2018;8:17147]

The risk estimates indicate that statin usage has minimal effect on dengue severity in the study population in Singapore, the investigators pointed out.

Despite the presence of several limitations, the present data “suggest that discontinuation of statins may not be necessary at the onset of dengue infection, and clinicians may adopt a watchful approach of continuing statins,” they added.

While discontinuation of statins may not be harmless even for short periods of time, an abrupt withdrawal has been shown to lead to impaired endothelial function via nitric oxide release and higher C-reactive protein levels, resulting in a proinflammatory state. [J Pharmacol Exp Ther 2011;339:324-328]

“With an ageing population compounded by a rise in obesity and associated comorbidities in Singapore, it is not uncommon that patients can present with dengue on a background of multiple medical problems that may pose a therapeutic challenge,” they said.