Statins in patients with COVID-19: a retrospective cohort study in Iranian COVID-19 patients

Abstract

Background The coronavirus disease 2019 (COVID-19) pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection has profoundly affected the lives of millions of people. To date, there is no approved vaccine or specific drug to prevent or treat COVID-19, while the infection is globally spreading at an alarming rate. Because the development of effective vaccines or novel drugs could take several months (if not years), repurposing existing drugs is considered a more efficient strategy that could save lives now. Statins constitute a class of lipid-lowering drugs with proven safety profiles and various known beneficial pleiotropic effects. Our previous investigations showed that statins have antiviral effects and are involved in the process of wound healing in the lung. This triggered us to evaluate if statin use reduces mortality in COVID-19 patients. Results After initial recruitment of 459 patients with COVID-19 (Shiraz province, Iran) and careful consideration of the exclusion criteria, a total of 150 patients, of which 75 received statins, were included in our retrospective study. Cox proportional-hazards regression models were used to estimate the association between statin use and rate of death. After propensity score matching, we found that statin use appeared to be associated with a lower risk of morbidity [HR = 0.85, 95% CI = (0.02, 3.93), P = 0.762] and lower risk of death [(HR = 0.76; 95% CI = (0.16, 3.72), P = 0.735)]; however, these associations did not reach statistical significance. Furthermore, statin use reduced the chance of being subjected to mechanical ventilation [OR = 0.96, 95% CI = (0.61–2.99), P = 0.942] and patients on statins showed a more normal computed tomography (CT) scan result [OR = 0.41, 95% CI = (0.07–2.33), P = 0.312]. Conclusions Although we could not demonstrate a significant association between statin use and a reduction in mortality in patients with COVID19, we do feel that our results are promising and of clinical relevance and warrant the need for prospective randomized controlled trials and extensive retrospective studies to further evaluate and validate the potential beneficial effects of statin treatment on clinical symptoms and mortality rates associated with COVID-19.

Statin use and mortality in COVID-19 patients: Updated systematic review and meta-analysis

“…Regarding the latter, the most commonly reported included: (i) Demographics: age, gender, body mass index; (ii) Comorbidities: hypertension, diabetes, coronary heart disease; (iii) Medications: angiotensin converting enzyme inhibitors or angiotensin II receptor blockers, antiplatelets, anticoagulants; (iv) Biochemical indices: lipids, creatinine levels. Some of the studies reported the duration of the follow-up, which ranged from a few days to several weeks [ 20 , 21 , [23] , [24] , [25] , [26] , 28 , 32 , 33 , 41 ]. In addition, 2 studies reported that the median length of hospitalization of the non-survivors was about 10 days [ 27 , 31 ], and 1 study reported that the majority of deaths occurred within the first 2 weeks of follow-up [ 20 ].…”

“…Ten studies (n = 41,807, weighted age 56 ± 8 years, men 51%, hypertension 34%, diabetes 21%, coronary heart disease 11%, statin users 14%) reported the adjusted hazard ratio for death in statin users versus non-users [ [20] , [21] , [22] , [23] , [24] , [25] , [26] , [27] , [28] , [29] ]. The pooled estimate of hazard ratio was 0.65 (95% confidence intervals [CI] 0.53, 0.81) ( Fig.…”

A systematic review of pregnant women with COVID-19 and their neonates

“…Since December 2019, COVID-19 has been a resident of the world. Early efforts ranged from the development of diagnostic assays [80][81][82][83] and specific therapeutics [84][85][86][87][88][89][90][91][92][93][94][95][96][97][98][99][100][101][102] to optimizing health monitoring [103,104]. Despite this effort, in addition to our knowledge and experience from the recent outbreaks [105], it mainly relied on non-pharmacological interventions to control the pandemic, e.g., quarantine and social isolation [106,107].…”

Autophagy, Unfolded Protein Response, and Neuropilin-1 Cross-Talk in SARS-CoV-2 Infection: What Can Be Learned from Other Coronaviruses

“…A retrospective cohort study conducted in Iranian COVID-19 patients highlighted that statins (40 mg daily) might reduce mortality in COVID-19 patients and improve lung function. They showed that using statins long-term before exposure to infection might be most effective therapeutically by controlling cytokine storm, targeting the autophagy pathway, mediating ACE2 expression, and decreasing lung scar formation in COVID-19 patients [150].…”