The use of statins was associated with reduced COVID-19 mortality: a systematic review and meta-analysis

Abstract

Background: Statins are widely used to treat people with metabolic and cardiovascular disorders. The effect of statins on coronavirus disease 2019 (COVID-19) is unclear. To investigate the association between statins and COVID-19 outcomes and, if possible, identify the subgroup population that benefits most from statin use.

Materials and methods: A systematic review and meta-analysis of published studies that included statin users and described COVID-19 outcomes through 10 November 2020. This study used the generic inverse variance method to perform meta-analyses with random-effects modelling. The main outcomes were evaluation of the need for invasive mechanical ventilator (IMV) support, the need for intensive care unit (ICU) care and death. All outcomes were measured as dichotomous variables.

Results: A total of 28 observational studies, covering data from 63,537 individuals with COVID-19, were included. The use of statins was significantly associated with decreased mortality (odds ratio [OR] = 0.71, 95% confidence interval [CI]: 0.55-0.92, I²=72%) and the need for IMV (OR = 0.81, 95% CI: 0.69-0.95, I²=0%) but was not linked to the need for ICU care (OR = 0.91, 95% CI: 0.55-1.51, I²=66%). Subgroup analysis further identified five types of studies in which statin users had even lower odds of death.

Conclusions: The use of statins was significantly associated with a reduced need for IMV and decreased mortality among individuals with COVID-19. Statins may not need to be discontinued because of concern for COVID-19 on admission. Further randomized controlled trial (RCTs) are needed to clarify the causal effect between statin use and severe COVID-19 outcomes.Key messagesParticipants in five types of studies were shown to have even lower odds of death when taking statins.The use of statins was significantly associated with a reduced need for invasive mechanical ventilation and decreased all-cause mortality among individuals with COVID-19. However, statin use did not prevent participants from needing care in the intensive care unit.The results justify performing randomized controlled trials (RCTs) to validate the benefits of statins on COVID-19 outcomes.

Keywords: COVID-19; SARS-CoV-2; mechanical ventilator; meta-analysis; mortality; statin.

Figure 1.

Forest plot showing the association between statin use and the need for intensive care unit care. The squares and bars represent the mean values and 95% CIs of the effect sizes, the area of the squares reflects the weight of the studies, and diamonds represent the combined effects.

Figure 2.

Forest plot showing the association between statins and the need for invasive mechanical ventilator support. The squares and bars represent the mean values and 95% CIs of the effect sizes, the area of the squares reflects the weight of the studies, and diamonds represent the combined effects.

Figure 3.

Forest plot showing the association between statins and mortality. The squares and bars represent the mean values and 95% CIs of the effect sizes, the area of the squares reflects the weight of the studies and diamonds represent the combined effects.