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Meta-Analysis
. 2022 Mar;22(2):167-181.
doi: 10.1007/s40256-021-00490-w. Epub 2021 Aug 3.

The Association Between the Use of Statins and Clinical Outcomes in Patients with COVID-19: A Systematic Review and Meta-analysis

Chia Siang Kow  1   2 , Syed Shahzad Hasan  3   4
Affiliations
Meta-Analysis

The Association Between the Use of Statins and Clinical Outcomes in Patients with COVID-19: A Systematic Review and Meta-analysis

Chia Siang Kow et al. Am J Cardiovasc Drugs. 2022 Mar.

Abstract

Purpose: Previously, we have reported potential clinical benefits with the use of statins in patients with coronavirus disease 2019 (COVID-19) in a meta-analysis, where there was a significantly reduced hazard for a fatal or severe course of illness with the use of statins, but the meta-analysis was limited by the small number of studies included, with small heterogeneity among studies, due to the unavailability of more studies at the point of literature search. We aimed to perform an updated systematic review and meta-analysis to summarize the existing evidence on the effect of statins on the clinical outcomes of patients with COVID-19.

Methods: Electronic databases, including PubMed, Google Scholar, and Scopus, and preprint servers were searched (last updated June 3, 2021) to identify studies investigating the association between the use of statins in patients with COVID-19 and the development of severe disease and/or mortality. Random-effects model meta-analyses were performed to estimate the pooled odds ratio (OR) or hazard ratio (HR) with 95% confidence intervals (CIs). The outcomes of interest were (1) all-cause mortality and (2) a composite endpoint of severe illness of COVID-19.

Results: Upon systematic literature search, we identified 35 studies, of which 32 studies reported the outcome of all-cause mortality and 15 studies reported the composite endpoint of severe COVID-19 illness between statin users versus non-statin users with COVID-19. Our meta-analysis revealed that the use of statins was associated with a significantly lower risks of all-cause mortality (HR = 0.70, 95% CI 0.58-0.84, n = 21,127, and OR = 0.63, 95% CI 0.51-0.79, n = 115,097) and the composite endpoint of severe illness (OR = 0.80, 95% CI 0.73-0.88, n = 10,081) in patients with COVID-19, compared to non-use of statins, at the current sample size.

Conclusion: Statin use is associated with a better prognosis in patients with COVID-19. Our findings provide a rationale to investigate the use of statins among patients with COVID-19 in large scale clinical trials.

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Conflict of interest statement

Chia Siang Kow and Syed Shazad Hasan declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Figures

Fig. 1
Fig. 1
Flow diagram of the study selection
Fig. 2
Fig. 2
A Forest plot showing the pooled OR of mortality between statin users and non-statin users with COVID-19. B Forest plot showing the pooled HR of mortality between statin users and non-statin users with COVID-19. CI confidence interval, COVID-19 coronavirus disease 2019, HR hazard ratio, OR odds ratio
Fig. 3
Fig. 3
A Forest plot showing the pooled OR of severe illness between statin users and non-statin users with COVID-19. B Forest plot showing the pooled HR of severe illness between statin users and non-statin users with COVID-19. CI confidence interval, COVID-19 coronavirus disease 2019, HR hazard ratio, OR odds ratio
Fig. 4
Fig. 4
A Funnel plot of publication bias with studies reporting outcomes on mortality. B Funnel plot of publication bias with studies reporting outcomes on severe illness
See this image and copyright information in PMC

References

    1. Kow CS, Hasan SS. Meta-analysis of effect of statins in patients with COVID-19. Am J Cardiol. 2020;134:153–155. - PMC - PubMed
    1. Castiglione V, Chiriacò M, Emdin M, Taddei S, Vergaro G. Statin therapy in COVID-19 infection. Eur Heart J Cardiovasc Pharmacother. 2020;6(4):258–259. - PMC - PubMed
    1. Kow CS, Thiruchelvam K, Hasan SS. Pharmacotherapeutic considerations for the management of cardiovascular diseases among hospitalized COVID-19 patients. Expert Rev Cardiovasc Ther. 2020;18(8):475–485. - PubMed
    1. WHO Solidarity Trial Consortium, Pan H, Peto R, et al. Repurposed Antiviral Drugs for Covid-19 - Interim WHO Solidarity Trial Results. N Engl J Med. 2021;384(6):497–511. - PMC - PubMed
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