Association between antecedent statin use and decreased mortality in hospitalized patients with COVID-19

Gupta, Aakriti; Madhavan, Mahesh V.; Poterucha, Timothy J.; DeFilippis, Ersilia M.; Hennessey, Jessica A.; Redfors, Björn; Eckhardt, C.; Bikdeli, Behnood; Platt, Jonathan; Nalbandian, Ani; Elias, Pierre; Cummings, Matthew J.; Nouri, Shayan Nabavi; Lawlor, Matthew; Ranard, Lauren S.; Li, Jianhua; Boyle, Claudia; Givens, Raymond C.; Brodie, Daniel; Krumholz, Harlan M.; Stone, Gregg W.; Sethi, Sanjum S.; Burkhoff, Daniel; Uriel, Nir; Schwartz, Allan; Leon, Martin B.; Kirtane, Ajay J.; Wan, Elaine; Parikh, Sahil A.

doi:10.1038/s41467-021-21553-1

Cited by 142 publications

(125 citation statements)

References 48 publications

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“… 75 Another study showed that outpatient statin treatment was associated with decreased COVID-19 mortality, although only 77% of outpatient-treated patients continued statin treatment after hospital admission. 76 If statins are withdrawn at the time of hospital admission, their beneficial effects are likely to be reduced. 77 , 78 Thus, statin treatment should be continued (or started) after hospital admission.…”

Section: Discussionmentioning

confidence: 99%

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

Byttebier¹,

Belmans²,

Alexander

et al. 2021

Human Vaccines & Immunotherapeutics

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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.

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Section: Discussionmentioning

confidence: 99%

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

Byttebier¹,

Belmans²,

Alexander

et al. 2021

Human Vaccines & Immunotherapeutics

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“…A total of 502 articles were identified by searching the database and related websites. After deduplication, record screening and eligibility assessment, 28 studies remained for qualitative synthesis, as shown in Table 1 [ 11 , 12 , 14 , 20–44 ]. Overall, these 28 selected articles evaluated 86,835 individuals with COVID-19 infection ( Supplementary Figure S1 ).…”

Section: Resultsmentioning

confidence: 99%

“…The last column of Table 1 detailed the outcomes of each study. Finally, 22 studies were eligible for quantitative synthesis [ 11 , 12 , 14 , 20–23 , 25 , 27 , 29 , 32–34 , 36–44 ].…”

Section: Resultsmentioning

confidence: 99%

“…The participants were individuals who were confirmed to have contracted COVID-19, were hospitalized for management and underwent a follow-up period of at least 28 d after study entry. Among these selected studies, 11 were conducted in the United States (USA) [ 12 , 21 , 23 , 31–34 , 36 , 38 , 39 , 41 ], 9 in Asia [ 11 , 20 , 24 , 28 , 29 , 40 , 42–44 ] and 8 in Europe [ 14 , 22 , 25–27 , 30 , 35 , 37 ]. The studies’ sample sizes varied from 50 to 37,212.…”

Section: Resultsmentioning

confidence: 99%

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The use of statins was associated with reduced COVID-19 mortality: a systematic review and meta-analysis

Lin

Chen

et al. 2021

Annals of Medicine

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Background Statins are widely used to treat people with metabolic and cardiovascular disorders. The effect of statins on coronavirus disease 2019 (COVID-19) is unclear. To investigate the association between statins and COVID-19 outcomes and, if possible, identify the subgroup population that benefits most from statin use. Materials and methods A systematic review and meta-analysis of published studies that included statin users and described COVID-19 outcomes through 10 November 2020. This study used the generic inverse variance method to perform meta-analyses with random-effects modelling. The main outcomes were evaluation of the need for invasive mechanical ventilator (IMV) support, the need for intensive care unit (ICU) care and death. All outcomes were measured as dichotomous variables. Results A total of 28 observational studies, covering data from 63,537 individuals with COVID-19, were included. The use of statins was significantly associated with decreased mortality (odds ratio [OR] = 0.71, 95% confidence interval [CI]: 0.55–0.92, I 2 =72%) and the need for IMV (OR = 0.81, 95% CI: 0.69–0.95, I 2 =0%) but was not linked to the need for ICU care (OR = 0.91, 95% CI: 0.55–1.51, I 2 =66%). Subgroup analysis further identified five types of studies in which statin users had even lower odds of death. Conclusions The use of statins was significantly associated with a reduced need for IMV and decreased mortality among individuals with COVID-19. Statins may not need to be discontinued because of concern for COVID-19 on admission. Further randomized controlled trial (RCTs) are needed to clarify the causal effect between statin use and severe COVID-19 outcomes. Key messages Participants in five types of studies were shown to have even lower odds of death when taking statins. The use of statins was significantly associated with a reduced need for invasive mechanical ventilation and decreased all-cause mortality among individuals with COVID-19. However, statin use did not prevent participants from needing care in the intensive care unit. The results justify performing randomized controlled trials (RCTs) to validate the benefits of statins on COVID-19 outcomes.

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“…We did not have information on whether our treated COVID-19 inpatients had also been treated as outpatients, although it is likely that many who had been treated as outpatients continued their treatment after hospital admission. However, several individual studies [e.g., [68][69][70][71][72] and meta-analyses [73,74] of statin treatment have yielded conflicting results. In these studies, treatment was ascertained largely on the basis of outpatient (not inpatient) information.…”

Section: Discussionmentioning

confidence: 99%

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

Byttebier¹,

Belmans²,

Alexander³

et al. 2021

Preprint

View full text Add to dashboard Cite

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.

show abstract

Association between antecedent statin use and decreased mortality in hospitalized patients with COVID-19

Cited by 142 publications

References 48 publications

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

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

The use of statins was associated with reduced COVID-19 mortality: a systematic review and meta-analysis

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

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