CHEST Guidelines-POINT--Should-Patients-Receiving-Statins-Prior-to-

POINT--Should-Patients-Receiving-Statins-Prior-to-

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The article addresses whether patients who are already taking statins prior to ICU admission should continue their statin therapy during their ICU stay. Proponents of continuing statin therapy argue that discontinuation could negatively influence outcomes for critical illnesses. They cite research indicating that statin withdrawal has been linked with poorer results in cases like acute coronary syndrome and post-surgery after vascular procedures. Observational data suggest ongoing statin use might improve mortality for various conditions, such as sepsis and candidemia.<br /><br />Statins are known to have pleiotropic effects beyond cholesterol reduction, including anti-inflammatory, antioxidant, and immune-modulation benefits. Randomized trials and retrospective studies have shown mixed results: some indicate a mortality benefit when inpatient statin therapy is continued for prior users, especially during severe inflammation. Additionally, continuing statins may decrease the incidence of ICU delirium, with ongoing use reducing delirium probability in critical conditions. Safety analyses consistently show no significant adverse effects compared to placebo, although some studies reported elevated enzyme levels needing further investigation.<br /><br />On the flip side, opponents argue there's insufficient evidence supporting broad statin use in the ICU. Given the complexity of critical illnesses, they suggest evaluating the necessity of each medication on a case-by-case basis, highlighting that statins' purported benefits in critical care settings largely stem from animal and in vitro studies, not always translated into clinical practice. They urge caution, stressing the importance of more definitive randomized trials to substantiate the potential benefits and risks of statin continuation in this setting.<br /><br />Overall, the decision to continue statin therapy in the ICU should weigh existing evidence, potential trends suggesting benefit, the patient's specific condition, and ongoing safety considerations while awaiting more comprehensive research outcomes. The discussion underscores the need for personalized approaches in critical care pharmacotherapy.

Keywords

statins

ICU admission

critical illness

statin therapy

mortality benefit

anti-inflammatory

ICU delirium

randomized trials

personalized medicine

pharmacotherapy