Letter to the Editor: Statins and COVID‐19: Efficacy Still to Be Proven

Meunier, Lucy; Meszaros, Magdalena; Pageaux, Georges‐Philippe

doi:10.1002/hep.31511

Cited by 3 publications

(3 citation statements)

References 4 publications

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“…Initially, 24 eligible observational studies were identified that reported valuable data on in-hospital mortality and/or COVID-19 disease severity, including three studies of patients with diabetes [14] , [15] , [17] . Of these selected studies, 14 provided data on in-hospital mortality [15] , [18] , [19] , [20] , [21] , [22] , [23] , [24] , [25] , [26] , [27] , [28] , [29] , [30] ( Table 1 )—although one reported only adjusted hazard ratios (HRs) with no crude numbers of deaths in statin users vs non-users and, therefore, could not be included in the meta-analysis (authors were contacted, but did not communicate their results) [26] —while 11 studies reported data on COVID-19 severity (as determined by ICU, IMV; Table 2 ) [18] , [22] , [23] , [27] , [28] , [30] , [31] , [32] , [33] , [34] , [35] . Also, a study by Tan et al [36] collected very few events in a Chinese population (personal communication from the authors), thereby preventing the use of this study in the final analysis.…”

Section: Resultsmentioning

confidence: 99%

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Statins and clinical outcomes with COVID-19: Meta-analyses of observational studies

Scheen

2021

Diabetes & Metabolism

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Aims People with cardiovascular disease or risk factors are at increased risk when exposed to SARS-CoV-2. Most are treated with statins, but the impact of these drugs on clinical outcomes of COVID-19 remains unclear. This report is therefore based on meta-analyses of retrospective observational studies aimed at investigating the impact of previous statin therapy in patients hospitalized for COVID-19. Methods In studies reporting on the clinical outcomes of COVID-19 in statin users vs non-users, two endpoints have been used—in-hospital death rates, and disease severity as assessed by admission to intensive care units (ICUs)—with a special focus on patients with diabetes. Results Regarding mortality, 13 studies were included in the meta-analysis for a total of 10,829 statin users (2517 deaths) and 31,893 non-users (7516 deaths): univariate analysis showed no statistically significant reduction in deaths (OR: 0.97, 95% CI: 0.92–1.03), although between-study heterogeneity was high (I² = 97%). As for disease severity, 11 studies were selected for a total of 3462 statin users (724 endpoints) and 10,560 non-users (1763 endpoints): here again, univariate analysis showed no reduction in severity (OR: 1.09, 95% CI: 0.99–1.22; I² = 93%). Collectively, in 10 studies using multivariable analysis adjusted for the more prevalent baseline risk factors among statin users, lower OR values were reported than with univariate analyses (0.73 ± 0.31 vs 1.44 ± 0.84, respectively; P = 0.0028; adjusted OR: P = 0.0237 vs non-users). Limited but conflicting findings were observed for diabetes patients. Conclusion Although no significant reductions in either in-hospital mortality or COVID-19 severity were reported among statin users compared with non-users after univariate comparisons, such reductions were observed after adjusting for confounding factors. These highly heterogeneous observational findings now require confirmation by ongoing randomized clinical trials.

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Section: Resultsmentioning

confidence: 99%

“…The list of included observational studies reporting data on disease severity (ICU, IMV) is presented in Table 2 [18] , [22] , [23] , [27] , [28] , [30] , [31] , [32] , [33] , [34] , [35] , while results of the corresponding meta-analysis are illustrated in Fig. 3 .…”

Section: Resultsmentioning

confidence: 99%

Statins and clinical outcomes with COVID-19: Meta-analyses of observational studies

Scheen

2021

Diabetes & Metabolism

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“…Probably in this category of patients, routine use of statins may be additive in increasing hepatic injury. In addition, the COVID-19 patient taking antivirals may be subject to drug interactions; remdesivir and statins are both substrates of cytochrome P450 3A4 (CYP3A4), which could promote adverse effects with concomitant administration [ 91 ]. In addition, some other important questions need to be clarified: is there a dose–response relationship underlying the beneficial effect of statins in Covid-19?…”

Section: Discussionmentioning

confidence: 99%

Plausible Positive Effects of Statins in COVID-19 Patient

Vitiello¹,

Ferrara²

2021

Cardiovasc Toxicol

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Since the onset of the global COVID-19 pandemic, there has been much discussion about the advantages and disadvantages of ongoing chronic drug therapies in SARS-CoV-2-positive patients. These discussions include also statins treatment. The statins are among the most widely used drugs in the global population. Statins aim to lower cholesterol, which is essential for many biological processes but can lead to heart disease if levels are too high; however, also the pleiotropic effects of statins are well known. So could the anti-inflammatory or the potential antiviral effects of statins be helpful in avoiding extreme inflammation and severity in COVID-19? To date, there are conflicting opinions on the effects of statins in the course of COVID-19 infection. The aim of this article is to describe the molecular and pharmacological basis of the pleiotropic effects of statins that could be more involved in the fight against COVID-19 infection and to investigate the current epidemiological evidence in the literature on the current and important topic.

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Invasive Mechanical Ventilation and Death Was More Likely in Patients with Lower LDL Cholesterol Levels during COVID-19 Hospitalization: A Retrospective Propensity-Matched Cohort Study

Mehta

Kharawala

Nagraj

et al. 2023

JoR

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Hyperlipidemia has been associated with worse outcomes in patients with Coronavirus disease 2019 (COVID-19). However, lower LDL-C (low-density lipoprotein cholesterol) levels have been associated with increased COVID-19 severity and mortality. We conducted a retrospective observational study of patients with COVID-19 admitted to New York City Health and Hospitals from 1 March 2020 to 31 October 2020, comparing pre-COVID-19 LDL-C levels or LDL-C levels obtained during COVID-19 hospitalization, with the need for invasive mechanical ventilation and death. Propensity score matching was performed using logistic regression models, and standardized mean differences were calculated. A total of 3020 patients (median age 61 years; 36% women) were included. In the matched cohort, on multivariate logistic regression analysis, LDL was inversely associated with in-hospital death (OR: 0.99, 95% CI: 0.986–0.999, p = 0.036). As a categorical variable, LDL > 70 mg/dL was associated with 47% lower likelihood of invasive mechanical ventilation (OR: 0.53, 95% CI: 0.29–0.95, p = 0.034). No significant association between pre-COVID-19 LDL and death or invasive mechanical ventilation was found (OR: 1.00, 95% CI 0.99–1.01, p = 0.833). Low LDL-C level measured during COVID-19 was associated with a higher likelihood of invasive mechanical ventilation and in-hospital death. A similar association was not found between pre-COVID-19 LDL-C and these outcomes. LDL-C levels obtained during COVID-19 are likely not reflective of the baseline lipid profile.

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Letter to the Editor: Statins and COVID‐19: Efficacy Still to Be Proven

Cited by 3 publications

References 4 publications

Statins and clinical outcomes with COVID-19: Meta-analyses of observational studies

Statins and clinical outcomes with COVID-19: Meta-analyses of observational studies

Plausible Positive Effects of Statins in COVID-19 Patient

Invasive Mechanical Ventilation and Death Was More Likely in Patients with Lower LDL Cholesterol Levels during COVID-19 Hospitalization: A Retrospective Propensity-Matched Cohort Study

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