Decreased Mortality Rate Among COVID-19 Patients Prescribed Statins: Data From Electronic Health Records in the US

Abstract

The severe respiratory illness due to SARS-CoV-2, the virus responsible for coronavirus disease 2019 (COVID-19), is triggered by an intense pro-inflammatory host response. Statins, prescribed primarily for lipid reduction, are known to have anti-inflammatory and immunomodulatory properties and have been associated with a reduced mortality rate among COVID-19 patients taking statins as reported in two recent retrospective studies. However, a meta-analysis that included nine studies showed that statin use did not improve in-hospital outcomes of those with COVID-19. In addition, concerns regarding the use of statins and an increase in COVID-19 infections have been raised, as statins may increase the expression of angiotensin-converting enzyme 2 (ACE2), the primary receptor for the SARS-CoV-2 virus. Our goal was to investigate the effect of statins in COVID-19 patients in a large, diverse patient population across the United States containing nearly 120,000 patients diagnosed with COVID-19. We used propensity score matching of demographics, comorbidities, and medication indication to compare statin-treated patients (N = 2,297) with matched controls (N = 4,594). We observed a small, but statistically significant, decrease in mortality among patients prescribed statins (16.1%) when compared with matched COVID-19-positive controls (18.0 to 20.6%). These results support previous evidence that statins do not increase COVID-19-related mortality and may, in fact, have a mitigating effect on severity of the disease reflected in a slight reduction in mortality. Mixed findings on effects of statins in COVID-19 patients reported in the literature should prompt prospective randomized controlled trials in order to define better who might be advantaged with respect to clinical outcomes.

Protective effects of statins on COVID-19 risk, severity and fatal outcome: a nationwide Swedish cohort study

“…Our main findings show that prior statin treatment was significantly associated with a reduced risk of COVID-19 test-positivity, diagnosis, hospitalization and mortality in the 3 studied population cohorts. These findings strengthen and support evidence on the hypothesis of pleiotropic protective effects of statins in COVID-19 from prior cohort studies [23][24][25][26][27][28][29][30] and align with evidence summarized by recent meta-analyses and systematic reviews on the association of statin use and the potential protective effects against progression and severity of COVID-19 15,16,18,31,32 . A recent Swedish cohort study using register data with Table 1.…”

The protective role of statins in COVID-19 patients: a retrospective observational study

“…The beneficial role of statins in COVID-19 patients is well documented in the literature [ 10 , 29 , 54 ]. The recent implementation of statins as preventive and treatment options in COVID-19 patients has been approved by the National Health Institute in the USA [ 55 ]. Statins are considered safe, cost-effective, and beneficial in hospitalized COVID-19 patients due to their favorable clinical outcomes, as seen in our study [ 10 ].…”

“…Numerous studies have favored the use of statins in COVID-19 patients [ 10 , 29 , 54 ]. The National Health Institute in the USA has even recommended that COVID-19 patients continue statin therapy to prevent and treat cardiovascular disease [ 55 ]. This safe and cost-effective drug has been proven to be beneficial during hospitalization and linked with better clinical outcomes [ 10 ].…”

Coronaviruses, cholesterol and statins: Involvement and application for Covid-19

“…In addition, taking into account the large number of cardio-vascular patients receiving long-term statin treatment, some recent retrospective observational clinical studies have been performed to assess a possible repercussion on the infection course. The current evidence from some separate retrospective studies in Covid-19 patients has shown that a baseline statin treatment was associated with a lower severity of disease [ [136] , [137] , [138] ] and a reduced mortality [ [139] , [140] , [141] , [142] , [143] , [144] , [145] , [146] ], although two studies did not find any association between exposure to statins and the outcome of Covid-19 infection [ 147 , 148 ]. Furthermore, some meta-analyses have been recently performed, globally revealing an overall 27–50% reduction, with respect to the control patients, in the pooled risk of developing severe form/mortality from Covid-19 [ [149] , [150] , [151] , [152] ], with the evidence of a marked patient heterogeneity in the various observations [ 151 , 152 ], in particular considering the qualitative difference between pre-admission and in-hospital use of statins [ 150 , 153 ].…”