Statins Linked to Reduced Mortality in COVID-19

Megan Brooks

August 28, 2020

Editor's note: Find the latest COVID-19 news and guidance in Medscape's Coronavirus Resource Center.

Treatment with statins was associated with a reduced risk of a severe or fatal course of COVID-19 by 30%, a meta-analysis of four published studies has shown.

In the analysis that included almost 9000 COVID-19 patients, there was a significantly reduced risk for fatal or severe COVID-19 among patients who were users of statins compared with non-users (pooled hazard ratio [HR], 0.70; 95% CI, 0.53 - 0.94).

Based on the findings, "it may be time we shift our focus to statins as the potential therapeutic options in COVID-19 patients," authors Syed Shahzad Hasan, PhD, University of Huddersfield, UK, and Chia Siang Kow, MPharm, International Medical University, Kuala Lumpur, Malaysia, wrote in a joint emailed comment to Medscape Medical News.

The study was published online August 11 in The American Journal of Cardiology.

Moderate to Good Quality Data

The analysis included four studies published up to July 27 of this year. Eligible studies included those with a cohort or case-control designs, enrolled patients with confirmed COVID-19, and had data available allowing comparison of the risk of severe illness and/or mortality among statin users vs non-users in adjusted analyses, the authors note. 

The four studies — one of "moderate" quality and three of "good" quality — included a total of 8990 COVID-19 patients.

In the pooled analysis, there was a significantly reduced risk for fatal or severe COVID-19 with use of statins compared to non-use of statins (pooled HR, 0.70; 95% CI, 0.53 - 0.94).

Their findings also "discredited the suggestion of harms with the use of statins in COVID-19 patients," the authors conclude.

"Since our meta-analysis included a fairly large total number of COVID-19 patients from four studies in which three are large-scale studies that adjusted extensively for multiple potential confounding factors, the findings can be considered reliable," Hasan and Kow write in their article.

Based on the results, "moderate-to-high intensity statin therapy is likely to be beneficial" in patients with COVID-19, they told Medscape Medical News.

However, they caution that more data from prospective studies are needed to substantiate the findings and to determine the appropriate regimen for a statin in COVID-19 patients.

Reached for comment, Yibin Wang, PhD, of the David Geffen School of Medicine, University of California, Los Angeles, said, "This is a very simple meta-analysis from four published studies which consistently reported a protective or neutral effect of statin usage on mortality or severe complications in COVID-19 patients."

Although the scope of this meta-analysis was "quite limited, the conclusion was not unexpected, as most of the clinical analysis so far reported supports the benefits or safety of statin usage in COVID-19 patients," Wang told Medscape Medical News.

Nonetheless, Questions Remain.

While there is "almost no dispute" about the safety of continuing statin therapy in COVID-19 patients, it remains to be determined if statin therapy can be implemented as an adjuvant or independent therapy and a part of the standard care for COVID-19 patients regardless of their hyperlipidemia status, said Wang, who was not associated with Hasan's and Kow's research.

"While statin usage is associated with several beneficial effects such as anti-inflammation and cytoprotection, these effects are usually observed from long-term usage rather than short-term/acute administration. Therefore, prospective studies and randomized trials should be conducted to test the efficacy of stain usage for COVID-19 patients with mild to severe symptoms," he noted.

"Considering the excellent record of statins as a safe and cheap drug, it is certainly a worthwhile effort to consider its broad-based usage for COVID-19 in order to lower the overall death and severe complications," Wang concluded.

Guillermo Rodriguez-Nava, MD, Department of Internal Medicine, AMITA Health Saint Francis Hospital, Evanston, Illinois, is first author on one of the studies included in this meta-analysis.

The retrospective single-center study found slower progression to death associated with atorvastatin in older patients with COVID-19 admitted to the intensive care unit. 

"Currently, there are hundreds of clinical trials evaluating a wide variety of pharmacological therapies for COVID-19. Unfortunately, these trials take time, and we are getting results in dribs and drabs," Rodriguez-Nava told Medscape Medical News.

"In the meantime, the best available evidence is observational, and COVID-19 treatment regiments will continue to evolve. Whether atorvastatin is effective against COVID-19 is still under investigation. Nevertheless, clinicians should consider at least continuing them in patients with COVID-19," he advised.

The study had no specific funding. Hasan, Kow, Wang and Rodriguez-Nava have disclosed no relationships relevant to this research.

Am J Cardiol. Published online August 11, 2020. Full text

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