The protective association between statins use and adverse outcomes among COVID-19 patients: A systematic review and meta-analysis

Abstract

Introduction Statins may reduce a cytokine storm, which has been hypothesized as a possible mechanism of severe COVID-19 pneumonia. The aim of this study was to conduct a systematic review and meta-analysis to report on adverse outcomes among COVID-19 patients by statin usage. Methods Literatures were searched from January 2019 to December 2020 to identify studies that reported the association between statin usage and adverse outcomes, including mortality, ICU admissions, and mechanical ventilation. Studies were meta-analyzed for mortality by the subgroups of ICU status and statin usage before and after COVID-19 hospitalization. Studies reporting an odds ratio (OR) and hazard ratio (HR) were analyzed separately. Results Thirteen cohorts, reporting on 110,078 patients, were included in this meta-analysis. Individuals who used statins before their COVID-19 hospitalization showed a similar risk of mortality, compared to those who did not use statins (HR 0.80, 95% CI: 0.50, 1.28; OR 0.62, 95% CI: 0.38, 1.03). Patients who were administered statins after their COVID-19 diagnosis were at a lower risk of mortality (HR 0.53, 95% CI: 0.46, 0.61; OR 0.57, 95% CI: 0.43, 0.75). The use of statins did not reduce the mortality of COVID-19 patients admitted to the ICU (OR 0.65; 95% CI: 0.26, 1.64). Among non-ICU patients, statin users were at a lower risk of mortality relative to non-statin users (HR 0.53, 95% CI: 0.46, 0.62; OR 0.64, 95% CI: 0.46, 0.88). Conclusion Patients administered statins after COVID-19 diagnosis or non-ICU admitted patients were at lower risk of mortality relative to non-statin users.

The Value of Clinical Frailty Scale (CFS) as a Prognostic Tool in Predicting Mortality in COVID-19—A Retrospective Cohort Study

“…The reason for previous observations was not the influence of drugs on COVID-19, but it was the effect of underlying comorbidities alone [19,20]. Moreover, statins, due to their anti-inflammatory effect, are associated with lower risk of fatal COVID-19 [21][22][23] among non-ICU patients and lower risk of mechanical ventilation treatment [22].…”

Impact of Working from Home on Cardiovascular Health: An Emerging Issue with the COVID-19 Pandemic

“…The adherence issue observed during lockdown may lead to worse cardiometabolic disease outcomes. Of note, among patients with COVID-19, statin use is a proxy of comorbidities that expose patients to more severe COVID-19 [60], although statin users seem to have a better COVID-19 clinical course than non-statin users [61]. The postulated mechanisms to explain this finding include direct cholesterol-lowering effects on viral infection/replication and several statin pleiotropic effects [62] due to their antithrombotic, anti-inflammatory, and immunomodulatory properties [63].…”

Circulating Lipids and COVID-19: Insights From Mendelian Randomization

“… 18 , 19 Similarly, a recent systematic review and meta-analysis including 110 078 hospitalized COVID-19 patients across thirteen retrospective cohorts found statin administration after diagnosis was associated with decreased mortality, particularly among individuals not requiring intensive care. 20 In contrast to the current study, which found a reduced risk of COVID-19 infection but not severity, observational studies have largely focused on the effects of statin treatment on COVID-19 outcomes rather than infection. The current MR study thus complements the published literature, which in sum suggests that therapies modifying circulating cholesterol and ApoB levels may have beneficial effects on COVID-19 infection and severity.…”