Statins use and COVID-19 outcomes in hospitalized patients

Abstract

Background There is an urgent need for novel therapeutic strategies for reversing COVID-19-related lung inflammation. Recent evidence has demonstrated that the cholesterol-lowering agents, statins, are associated with reduced mortality in patients with various respiratory infections. We sought to investigate the relationship between statin use and COVID-19 disease severity in hospitalized patients. Methods A retrospective analysis of COVID-19 patients admitted to the Johns Hopkins Medical Institutions between March 1, 2020 and June 30, 2020 was performed. The outcomes of interest were mortality and severe COVID-19 infection, as defined by prolonged hospital stay (≥ 7 days) and/ or invasive mechanical ventilation. Logistic regression, Cox proportional hazards regression and propensity score matching were used to obtain both univariable and multivariable associations between covariates and outcomes in addition to the average treatment effect of statin use. Results Of the 4,447 patients who met our inclusion criteria, 594 (13.4%) patients were exposed to statins on admission, of which 340 (57.2%) were male. The mean age was higher in statin users compared to non-users [64.9 ± 13.4 vs. 45.5 ± 16.6 years, p <0.001]. The average treatment effect of statin use on COVID-19-related mortality was RR = 1.00 (95% CI: 0.99–1.01, p = 0.928), while its effect on severe COVID-19 infection was RR = 1.18 (95% CI: 1.11–1.27, p <0.001). Conclusion Statin use was not associated with altered mortality, but with an 18% increased risk of severe COVID-19 infection.

Survival of the hospitalized patients with COVID‐19 receiving atorvastatin: A randomized clinical trial

“…Our findings are consistent with this study that emphasized the deleterious effects of statins on COVID‐19 clinical outcomes including prolonged hospital stay (≥7 days) and/or need for invasive mechanical ventilation although this study didn't show any association between statin use and mortality 24 . Furthermore, the results from the CORONADO study verify our data that reported routine use of statins increased COVID‐19 related mortality in inpatients with type 2 diabetes 25 .…”

Lipid profile changes in patients with COVID-19 referred to medical centers in Kermanshah, Iran; a case–control study

“…Thus, statin use was shown not to be associated with altered mortality, but it was found to be associated with an increased risk of severe COVID-19 infection (by 18%). 37 It is unclear whether hypolipidemia due to statin use may be associated with pneumonia. SARS CoV-2 alters liver function and vascular permeability, reducing LDL biosynthesis and causing leakage of cholesterol and plasma lipids into the alveolar space, thus lowering plasma lipid levels.…”

Differential Co-Expression Network Analysis Reveals Key Hub-High Traffic Genes as Potential Therapeutic Targets for COVID-19 Pandemic

“…Additionally, in terms of individual genes in the turquoise module, we identified hub-high traffic genes such as UTP14A ( 398 ), RUVBL2 ( 139 ), PRKCD ( 280 , 399 ), KEAP1 ( 400 – 402 ), CEBPA (TF) ( 403 ), RPL26L1 ( 404 ), PTPN6 ( 255 ), PPARA (TF) ( 405 ), TNFRSF1A ( 406 – 408 ), IKBKB ( 275 , 409 ), TFEB (TF) ( 410 , 411 ), PSMD4 ( 412 ), and ARHGAP1 ( 413 ), important components in immunopathogenesis of SARS-CoV-2. For example, the TNF receptor superfamily member 1A ( TNFRSF1A ) hub-high traffic gene may be a biomarker of mortality in severe COVID-19 patients, as increased expression of this gene was significantly correlated with mortalities ( 414 ).…”