Improved COVID-19 ICU admission and mortality outcomes following treatment with statins: a systematic review and meta-analysis

Abstract

IntroductionApproximately 1% of the world population has now been infected by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which causes coronavirus disease 2019 (COVID-19). With cases still rising and vaccines just beginning to rollout, we are still several months away from seeing reductions in daily case numbers, hospitalisations, and mortality. Therefore, there is a still an urgent need to control the disease spread by repurposing existing therapeutics. Owing to antiviral, anti-inflammatory, immunomodulatory, and cardioprotective actions, statin therapy has been considered as a plausible approach to improve COVID-19 outcomes.Material and methodsWe carried out a meta-analysis to investigate the effect of statins on 3 COVID-19 outcomes: intensive care unit (ICU) admission, tracheal intubation, and death. We systematically searched the PubMed, Web of Science, Scopus, and ProQuest databases using keywords related to our aims up to November 2, 2020. All published observational studies and randomised clinical trials on COVID-19 and statins were retrieved. Statistical analysis with random effects modelling was performed using STATA16 software.ResultsThe final selected studies (n = 24 studies; 32,715 patients) showed significant reductions in ICU admission (OR = 0.78, 95% CI: 0.58–1.06; n = 10; I2 = 58.5%) and death (OR = 0.70, 95% CI: 0.55–0.88; n = 21; I2 = 82.5%) outcomes, with no significant effect on tracheal intubation (OR = 0.79; 95% CI: 0.57–1.11; n = 7; I2 = 89.0%). Furthermore, subgroup analysis suggested that death was reduced further by in-hospital application of statins (OR = 0.40, 95% CI: 0.22–0.73, n = 3; I2 = 82.5%), compared with pre-hospital use (OR = 0.77, 95% CI: 0.60–0.98, n = 18; I2 = 81.8%).ConclusionsThese findings call attention to the need for systematic clinical studies to assess both pre- and in-hospital use of statins as a potential means of reducing COVID-19 disease severity, particularly in terms of reduction of ICU admission and total mortality reduction.

Altered Vascular Endothelium-Dependent Responsiveness in Frail Elderly Patients Recovering from COVID-19 Pneumonia: Preliminary Evidence

“…This study could also open the discussion about possible treatments of this dysfunction: it is known that physical exercise can improve endothelial function [30,31], and rehabilitation attempts could lead to a beneficial improvement as well. Other treatments that could produce improvement are specific classes of dietary supplements [32] or drugs [33][34][35].…”

Susceptibility of β-Thalassemia Heterozygotes to COVID-19

“…While hyperlipidemia and obesity are common co-morbidities with negative impacts on most associated pathologies [14], in the present study patients with hyperlipidemia were clearly protected from mortality due to COVID-19, with a 60% lesser probability of death compared to other patients (OR = 0.38). Known to reduce COVID-19 mortality [15][16][17], statins that were prescribed to hyperlipidemic patients may account for patients' protection against COVID-19 associated death. In addition to their primary lipid-lowering effect, statins appear to regulate vasodilation via a receptor of the novel coronavirus, angiotensin-converting enzyme 2 (ACE2) [18].…”

Direct and Indirect Effects of SARS-CoV-2 Pandemic in Subjects with Familial Hypercholesterolemia: A Single Lipid-Center Real-World Evaluation

“…Finally, in our study, none of the affected FH subjects required hospitalization; future studies in larger cohorts of FH subjects are needed to confirm and explain this preliminary finding. However, previous findings showed that among subjects with SARS-CoV-2 infection requiring hospitalization, statin users were associated with lower mortality than non-statin users [ 18 , 19 , 20 ]. Taking these findings into consideration, a possible hypothesis could be that subjects with a long duration of statin therapy, such as FH subjects, could be characterized by a reduced need for hospitalization [ 21 ].…”