Systematic Review and Meta-Analysis of Statin Use and Mortality, Intensive Care Unit Admission and Requirement for Mechanical Ventilation in COVID-19 Patients

Abstract

There is mounting evidence that statin use is beneficial for COVID-19 outcomes. We performed a systematic review and meta-analysis to evaluate the association between statin use and mortality, intensive care unit (ICU) admission and mechanical ventilation in COVID-19 patients, on studies which provided covariate adjusted effect estimates, or performed propensity score matching. We searched PubMed, Embase, Web of Science and Scopus for studies and extracted odds or hazard ratios for specified outcome measures. Data synthesis was performed using a random-effects inverse variance method. Risk of bias, heterogeneity and publication bias were analyzed using standard methods. Our results show that statin use was associated with significant reductions in mortality (OR = 0.72, 95% CI: 0.67–0.77; HR = 0.74, 95% CI: 0.69, 0.79), ICU admission (OR = 0.94, 95% CI: 0.89–0.99; HR = 0.76, 95% CI: 0.60–0.96) and mechanical ventilation (OR = 0.84, 95% CI: 0.78–0.92; HR = 0.67, 95% CI: 0.47–0.97). Nevertheless, current retrospective studies are based on the antecedent use of statins prior to infection and/or continued use of statin after hospital admission. The results may not apply to the de novo commencement of statin treatment after developing COVID-19 infection. Prospective studies are lacking and necessary.

The impact of statin therapy on in‐hospital prognosis and endothelial function of patients at high‐to‐very high cardiovascular risk admitted for COVID‐19

“…In detail, several previous observational studies and meta-analyses of observational studies show that preadmission statin therapy may reduce mortality in patients hospitalized for COVID-19. [11][12][13][14][15][16][17][22][23][24] Moreover, recent studies indicate that statin therapy may protect from worse prognosis even in patients with higher CV risk. 22,[28][29][30][31] Indeed, a retrospective study published in 2021 reports that statin users with CVD or CV risk factors have a lower risk of requiring extracorporeal membrane oxygenation and developing septic shock during hospitalization for COVID-19.…”

“…To date, several observational studies and meta‐analyses of observational studies have investigated the association between statin therapy and COVID‐19 prognosis, showing inconsistent results 11–24 . Overall, there is conflicting evidence on the impact of in‐hospital statin therapy (either continuation or introduction de novo) on the clinical course of COVID‐19 11,13,14,18–21 .…”

“…Overall, there is conflicting evidence on the impact of in‐hospital statin therapy (either continuation or introduction de novo) on the clinical course of COVID‐19 11,13,14,18–21 . Instead, most available studies suggest that preadmission statin therapy may reduce the risk of adverse clinical outcomes in patients hospitalized for COVID‐19 11–17,19,21–24 . However, data on the relationship between preadmission statin use and the clinical course of COVID‐19 in patients with high‐to‐very high CV risk, who are the most vulnerable with regard to COVID‐19 complications, 25–27 albeit being consistent are still scarce 22,28–31 .…”

“…6,[8][9][10] To date, several observational studies and meta-analyses of observational studies have investigated the association between statin therapy and COVID-19 prognosis, showing inconsistent results. [11][12][13][14][15][16][17][18][19][20][21][22][23][24] Overall, there is conflicting evidence on the impact of in-hospital statin therapy (either continuation or introduction de novo) on the clinical course of COVID-19. 11,13,14,[18][19][20][21] Instead, most available studies suggest that preadmission statin therapy may reduce the risk of adverse clinical outcomes in patients hospitalized for COVID-19.…”

“…11,13,14,[18][19][20][21] Instead, most available studies suggest that preadmission statin therapy may reduce the risk of adverse clinical outcomes in patients hospitalized for COVID-19. [11][12][13][14][15][16][17]19,[21][22][23][24] However, data on the relationship between preadmission statin use and the clinical course of COVID-19 in patients with high-to-very high CV risk, who are the most vulnerable with regard to COVID-19 complications, [25][26][27] albeit being consistent are still scarce. 22,[28][29][30][31] Moreover, although some previous studies have attempted to provide a direct insight into the possible biological mechanisms underlying the beneficial effects of statin therapy in the acute phase of COVID-19 (e.g., attenuation of inflammation and reduced myocardial injury), 17,22,32 the impact of statin-mediated endothelium protection on COVID-19 clinical outcomes has not been explored so far.…”