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. 2021 May 28;8(7):ofab284.
doi: 10.1093/ofid/ofab284. eCollection 2021 Jul.

Prior Statin Use and Risk of Mortality and Severe Disease From Coronavirus Disease 2019: A Systematic Review and Meta-analysis

Zachary A Yetmar  1 , Supavit Chesdachai  1 , Tarek Kashour  2 , Muhammad Riaz  3 , Danielle J Gerberi  4 , Andrew D Badley  1   5 , Elie F Berbari  1 , Imad M Tleyjeh  1   6   7   8
Affiliations

Prior Statin Use and Risk of Mortality and Severe Disease From Coronavirus Disease 2019: A Systematic Review and Meta-analysis

Zachary A Yetmar et al. Open Forum Infect Dis. .

Abstract

Background: Statins up-regulate angiotensin-converting enzyme 2, the receptor of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), while also exhibiting pleiotropic antiviral, antithrombotic, and anti-inflammatory properties. Uncertainties exist about their effect on the course of SARS-CoV-2 infection. We sought to systematically review the literature and perform a meta-analysis to examine the association between prior statin use and outcomes of patients with coronavirus disease 2019 (COVID-19).

Methods: We searched Ovid Medline, Web of Science, Scopus, and the preprint server medRxiv from inception to December 2020. We assessed the quality of eligible studies with the Newcastle-Ottawa quality scale. We pooled adjusted relative risk (aRRs) of the association between prior statin use and outcomes of patients with COVID-19 using the DerSimonian-Laird random-effects model and assessed heterogeneity using the I 2 index.

Results: Overall, 19 (16 cohorts and 3 case-control) studies were eligible, with a total of 395 513 patients. Sixteen of 19 studies had low or moderate risk of bias. Among 109 080 patients enrolled in 13 separate studies, prior statin use was associated with a lower risk of mortality (pooled aRR, 0.65 [95% confidence interval {CI}, .56-.77], I 2 = 84.1%) and a reduced risk of severe COVID-19 was also observed in 48 110 patients enrolled in 9 studies (pooled aRR, 0.73 [95% CI, .57-.94], I 2 = 82.8%), with no evidence of publication bias.

Conclusions: Cumulative evidence suggests that prior statin use is associated with lower risks of mortality or severe disease in patients with COVID-19. These data support the continued use of statins medications in patients with an indication for lipid-lowering therapy during the COVID-19 pandemic.

Keywords: COVID-19; SARS-CoV-2; meta-analysis; mortality; statins.

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Figures

Figure 1.
Figure 1.
Preferred Reporting Items for Systematic Reviews and Meta-​Analyses (PRISMA) flow diagram of included studies.
Figure 2.
Figure 2.
Meta-analysis of adjusted effects estimates of association between statin use and mortality from coronavirus disease 2019. Abbreviations: CI, confidence interval; ID, identification.
Figure 3.
Figure 3.
Meta-analysis of adjusted effects estimates of association between statin use and severe coronavirus disease 2019.
See this image and copyright information in PMC

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