Hospital mortality in COVID-19 patients in Belgium treated with statins, ACE inhibitors and/or ARBs

Abstract

The COVID-19 pandemic has disrupted life throughout the world. Newly developed vaccines promise relief to people who live in high-income countries, although vaccines and expensive new treatments are unlikely to arrive in time to help people who live in low-and middle-income countries. The pathogenesis of COVID-19 is characterized by endothelial dysfunction. Several widely available drugs like statins, ACE inhibitors (ACEIs) and angiotensin receptor blockers (ARBs) have immunometabolic activities that (among other things) maintain or restore endothelial cell function. For this reason, we undertook an observational study in four Belgian hospitals to determine whether in-hospital treatment with these drugs could improve survival in 959 COVID-19 patients. We found that treatment with statins and ACEIs/ARBs reduced 28-day mortality in hospitalized COVID-19 patients. Moreover, combination treatment with these drugs resulted in a 3-fold reduction in the odds of hospital mortality (OR = 0.33; 95% CI 0.17–0.69). These findings were in general agreement with other published studies. Additional observational studies and clinical trials are needed to convincingly show that in-hospital treatment with statins, ACEIs/ARBs, and especially their combination saves lives.

Obesity and COVID-19: renin–angiotensin as a mediator of morbidity and mortality

“…Dyett (13) addresses the growing evidence suggesting that obesity may be the second most important risk factor after age for developing serious COVID-19 disease. This outcome is entirely consistent with the pattern described previously with different viruses where for example a critical consideration of the HIV includes viral persistence in cellular sites that preclude eradication, with the possibility that adipose tissue is a viral reservoir (14) both for the SARS-COV2 virus (15) as with HIV (16) . However evidence on the role of obesity as a lipid reservoir on 'long COVID' is currently sparse.…”

“…Mechanistically, many of the pathophysiological contribution of obesity on worsened organ function are due to inflammation on top of an activated RAS system. It would seem that the combination of such lifestyle modifications together with 'treating the host' principles with repurposed drugs to reduce the activity of the RAS (18) and statins (16) to inhibit inflammation would appear to be key elements of strategy for COVID-19 treatment.…”

Managing Endothelial Dysfunction in COVID-19: A Pilot, Double-Blind, Placebo-Controlled, Randomized Clinical Trial at the Lebanese American University Medical Center - Rizk Hospital (MEDIC-LAUMCRH)

“…al demonstrated in a retrospective study that the concurrent treatment with statins, aspirin, and ACE/ARBs, which have protective effects on the endothelium, resulted in a 3-fold reduction in the odds of hospital mortality. 20 In our study, treatment with the endothelial dysfunction protocol resulted in no benefit probably due to the small sample size and the fact that the meantime after presentation was around 7.5 days. By then, the acute phase had already passed and the endothelial damage incurred probably became irreversible with permanent target organ damage.…”

Statin withdrawal and treating COVID‐19 patients

“…Moreover, none of the 14 meta‐analyses S43−S55 mentioned the problem of statin withdrawal, although several included information on better outcomes with inpatient compared with outpatient treatment. S50,S53,S55,S56 Only one of the 11 studies of in‐hospital statin treatment 6 ,also S65 cited any references on the negative consequences of statin withdrawal.…”