Association between statin use and outcomes in patients with coronavirus disease 2019 (COVID-19): a nationwide cohort study

Abstract

ObjectiveTo investigate the association between recent statin exposure and risk of severe COVID-19 infection and all-cause mortality in patients with COVID-19 in Denmark.Design and settingObservational cohort study using data from Danish nationwide registries.ParticipantsPatients diagnosed with COVID-19 from 22 February 2020 to 17 May 2020 were followed from date of diagnosis until outcome of interest, death or 17 May 2020.InterventionsUse of statins, defined as a redeemed drug prescription in the 6 months prior to COVID-19 diagnosis.Primary and secondary outcome measuresAll-cause mortality, severe COVID-19 infection and the composite.ResultsThe study population comprised 4842 patients with COVID-19 (median age 54 years (25th–75th percentile, 40–72), 47.1% men), of whom 843 (17.4%) redeemed a prescription of statins. Patients with statin exposure were more often men and had a greater prevalence of comorbidities. The median follow-up was 44 days. After adjustment for age, sex, ethnicity, socioeconomic status and comorbidities, statin exposure was not associated with a significantly different risk of mortality (HR 0.96 (95% CI 0.78 to 1.18); 30-day standardised absolute risk (SAR), 9.8% (8.7% to 11.0%) vs 9.5% (8.2% to 10.8%); SAR difference, −0.4% (−1.9% to 1.2%)), severe COVID-19 infection (HR 1.16 (95% CI 0.95 to 1.41); 30-day SAR, 13.0% (11.8% to 14.2%) vs 14.9% (12.8% to 17.1%); SAR difference, 1.9% (−0.7% to 4.5%)), and the composite outcome of all-cause mortality or severe COVID-19 infection (HR 1.05 (95% CI 0.89 to 1.23); 30-day SAR, 17.6% (16.4% to 18.8%) vs 18.2% (16.4% to 20.1%); SAR difference, 0.6% (−1.6% to 2.9%)). The results were consistent across subgroups of age, sex and presumed indication for statin therapy. Among patients with statin exposure, there was no difference between statin drug or treatment intensity with respect to outcomes.ConclusionsRecent statin exposure in patients with COVID-19 infection was not associated with an increased or decreased risk of all-cause mortality or severe infection.

Statins Are Associated with Improved 28-day Mortality in Patients Hospitalized with SARS-CoV-2 Infection

“…The composition of our cohort was similar to other published patient databases of patients with COVID-19 (17, 22, 24). The median age of patients was 60 years old (IQR 47-73 years).…”

“…Observational studies have similarly yielded mixed results regarding the effects of statins in COVID-19. These investigations have been limited by small sample size (16-19), insufficient adjustments for time varying confounders (16, 20, 21), and lack of a sub-cohort newly initiated on statins for COVID-19 (20, 22-24).…”

Statin Use Is Associated with a Decreased Risk of Mortality among Patients with COVID-19

“…We further examined 26 full-text articles and searched the references of relevant articles, retrieving 2 additional publications. Finally, 22 studies met all inclusion criteria [ 1 , 9 , 10 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 ]. The flow diagram of the systematic articles search is presented in Figure 1 .…”

“…3-hydroxy-3-methyl-glutayl-CoA (HMG-CoA) reductase inhibitors, statins, are the most widely prescribed medication for the treatment of cardiovascular disease, including stroke, hyperlipidemia, and myocardial infarction [ 6 , 7 , 8 ]. Recently, epidemiological studies have highlighted the association between the statin and the reduced risk of severity and mortality among COVID-19 patients [ 9 , 10 ]. Statin can reduce the rate of mortality in various ways, like increasing vascular endothelial function [ 11 ], blocking miR-133a expression [ 12 ], reducing acute-phase proteins level (like C-reactive protein) [ 13 ], and anti-inflammatory effects [ 14 ].…”

A Phenome-Wide Association Study (PheWAS) of COVID-19 Outcomes by Race Using the Electronic Health Records Data in Michigan Medicine

“…While potentially relevant, we did not explore past medication data in our analyses because the available EHR data did not provide comprehensive medication coverage but predominantly medication orders and administrations for hospitalized patients. Other population-based cohorts with prescription registries, as exemplified by Butt and colleagues [ 36 ], might be better suited for such an exploration.…”