COVID-19 Evidence Alerts
from McMaster PLUSTM

Current best evidence for clinical care (more info)

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Treatment Wu CC, Lee AJ, Su CH, et al. Statin Use Is Associated with a Decreased Risk of Mortality among Patients with COVID-19. J Clin Med. 2021 Apr 1;10(7). pii: jcm10071450. doi: 10.3390/jcm10071450.
Abstract

BACKGROUND: Recent epidemiological studies remain controversial regarding the association between statin use and reducing the risk of mortality among individuals with COVID-19.

OBJECTIVE: The objective of this study was to clarify the association between statin use and the risk of mortality among patients with COVID-19.

METHODS: We conducted a systematic articles search of online databases (PubMed, EMBASE, Scopus, and Web of Science) between 1 February 2020 and 20 February 2021, with no restriction on language. The following search terms were used: "Statins" and "COVID-19 mortality or COVID19 mortality or SARS-CoV-2 related mortality". Two authors individually examined all articles and followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines for study inclusion and exclusion. The overall risk ratio (RRs) with 95% confidence interval (CI) was calculated to show the strength of the association and the heterogeneity among the studies was presented Q and I2 statistic.

RESULTS: Twenty-eight studies were assessed for eligibility and 22 studies met the inclusion criteria. Statin use was associated with a significantly decreased risk of mortality among patients with COVID-19 (RR adjusted = 0.64; 95% CI: 0.57-0.72, p < 0.001). Moreover, statin use both before and after the admission was associated with lowering the risk of mortality among the COVID-19 patients (RR adjusted;before = 0.69; 95% CI: 0.56-0.84, p < 0.001 and RR adjusted;after = 0.57; 95% CI: 0.54-0.60, p < 0.001).

CONCLUSION: This comprehensive study showed that statin use is associated with a decreased risk of mortality among individuals with COVID-19. A randomized control trial is needed to confirm and refute the association between them.

Ratings
Discipline / Specialty Area Score
Hospital Doctor/Hospitalists
Internal Medicine
Cardiology
Infectious Disease
Intensivist/Critical Care
Family Medicine (FM)/General Practice (GP)
General Internal Medicine-Primary Care(US)
Comments from MORE raters

General Internal Medicine-Primary Care(US) rater

This meta-analysis of retrospective observational studies with significant heterogeneity (wherein of the 3 largest studies, 1 found increased risk with statins and 2 found decreased risk) is useful only for hypothesis generation. It does not provide evidence for starting statin use when COVID-19 is diagnosed, since statin use was likely not initiated at the time of diagnosis in any of the studies.

General Internal Medicine-Primary Care(US) rater

There were some similar initially positive retrospective studies around statins in sepsis about 10 years ago with negative prospective data that came out since. We have to consider what statin therapy before and after COVID-19 may be an indirect maker (namely engagement in primary care or other healthcare services).

Hospital Doctor/Hospitalists rater

This meta-analysis (of an increasing number of observational studies) shows an epidemiological association between statin use and reduced mortality in COVID-19. Previous associations of statin use and a variety of clinical outcomes have not been confirmed in properly conducted trials. Ongoing clinical trials are now evaluating a potential role for statins in COVID-19. In the mean time, patients with a clinical indication of statin treatment must continue this treatment. A potential indication for statins in COVID-19 remains to be properly evaluated.

Hospital Doctor/Hospitalists rater

These are provocative findings of meta analysis of observational studies looking at the association between statin use and mortality from COVID-19. However, I would have liked to have seen absolute mortality rates among statin users versus nonusers, not just relative rates, to determine clinical significance. This would not change my clinical practice at this time.

Infectious Disease rater

This is another of those knowledge gap issues pertaining to Covid-19 research. It would need further validation with more robust RCTs (well controlled for other confounding factors) as Covid-19 patients would likely be on multiple other therapies!