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

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 fora 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 (I-2 = 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; I-2 = 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. (C) 2020 Elsevier Masson SAS. All rights reserved.

Automated summary

In univariate analysis, no significant reductions in either in-hospital mortality or COVID-19 severity were reported among statin users compared with non-users. However, after considering confounding factors, multivariable analysis showed that statin therapy may reduce the mortality and disease severity in COVID-19 patients.