Statin Therapy May Reduce Mortality in Patients Hospitalized with COVID-19

Spectrum of Effects of Statin Therapy and Impact on COVID-19

The use of statins affects not only lipid oxidation but also inflammatory, immunomodulatory, and endothelial functions. Data from computer models suggest that statin molecules interfere with the main protease of the SARS-CoV-2 virus, which could potentially lead to an inhibitory effect on virus replication. Therefore, some authors recommend using statins as an adjunct therapy in COVID-19.

On the other hand, administering statins in animal models led to increased expression of ACE2 proteins, which are considered the primary receptors allowing the coronavirus to enter the cell. Statins could also exacerbate myopathies associated with COVID-19, and their interaction profile, especially with antiviral treatments, needs to be considered.

The presented study aimed to clarify the potential benefits of ongoing statin therapy in patients hospitalized with COVID-19.

Methodology and Objectives of the Analysis

The retrospective observational study used data on patients hospitalized in 19 Catalan hospitals. Data on the patients' medical history, lipoprotein profile, ongoing treatment, and clinical data of adult patients with PCR-confirmed SARS-CoV-2 infection who were hospitalized for at least 24 hours were collected. The analysis evaluated whether patients had used statins in the previous year, at what dose, and whether the therapy continued during hospitalization.

The primary goal was to assess patient mortality, and the secondary goal was to analyze the impact of statin therapy on the clinical course of the disease. For mortality analysis, controls and cases were matched concerning demographic and clinical characteristics using a genetic matching model. The Cox proportional hazards model and other statistical models were used to evaluate risk levels.

Results

Data from 2157 patients (42.8% women) with a median age of 67 years were included. A total of 581 patients (38.7% women) were on statin therapy upon hospital admission, with 30% on a high daily dose (atorvastatin 80 mg or rosuvastatin 20 mg). For 57.8% of patients, therapy continued during hospitalization; for 42.2%, it was interrupted within 48 hours of hospital admission. Patients on statins were on average 11 years older than the untreated cohort, which also had significantly fewer comorbidities.

There were 353 deaths in total, with an overall mortality rate of 19.8% in the statin-treated group and 15% in the untreated group. After matching controls and cases, the mortality rate in the control group not treated with statins was 25.4% (hazard ratio [HR] 0.58; 95% confidence interval [CI] 0.39-0.89; p = 0.01). For patients who continued prescribed statin therapy after hospital admission, the mortality rate was even lower (17.4%; p = 0.045).

The incidence of complications associated with severe disease (e.g., acute respiratory distress syndrome, acute kidney failure, or the need for tracheal intubation) was lower in patients treated with statins, but the observed difference was not statistically significant.

Conclusion

A lower mortality rate was observed in patients hospitalized with COVID-19 who had been using statins before hospital admission. Statin therapy should not be interrupted during hospital stays.

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Source: Masana L., Correig E., Rodríguez-Borjabad C., et al. Effect of statin therapy on SARS-CoV-2 infection-related mortality in hospitalized patients. Eur Heart J Cardiovasc Pharmacother 2020 Nov 2: pvaa128, doi: 10.1093/ehjcvp/pvaa128 [Epub ahead of print].