The impact of atherosclerotic cardiovascular disease, dyslipidaemia and lipid lowering therapy on Coronavirus disease 2019 outcomes: an examination of the available evidence

Abstract

Purpose of review Coronavirus Disease 2019 (COVID19) has caused significant global morbidity and mortality, especially in persons with underlying cardiovascular disease. There have been concerns that lipid-lowering therapy (LLT) increases angiotensin-converting enzyme 2 levels. Conversely, pleiotropic effects of statins can theoretically protect against severe COVID19 infection, supporting evidence from other respiratory illnesses in which statin use probably confers benefit. Recent findings There is an abundance of studies that show that statins are safe and potentially protect against severe COVID19 infection (critical illness and death), even when adjustment for potential confounders is undertaken. However, the evidence is limited to retrospective cohorts. The benefit for patients with diabetes is less clear. There is a paucity of evidence for other LLT agents. Available clinical guidelines recommend the ongoing use of LLT in patients with COVID19 (unless specifically contra-indicated) and the data from available studies support these. Summary In patients with COVID19 infection, LLT should be continued. However, the current findings need substantiating in larger prospective clinical studies with specific examination of the possible mechanisms by which LLT confers benefit from COVID19.

Atherosclerosis, Cardiovascular Disease, and COVID-19: A Narrative Review

“…Statins have been thought to confer a potential advantage against progression to severe COVID-19 infection with different proposed effects including anti-inflammatory, antithrombotic, antiviral protease, and protection against endothelial dysfunction [ 75 ]. Thus, at the beginning of the pandemic, the evidence pointed out that statin use was associated with improved survival [ 76 ] and seemed to lower the incidence of severe COVID-19 and mortality rates [ 22 ].…”