Statins Use in Patients with Cardiovascular Diseases and COVID-19 Outcomes: An Italian Population-Based Cohort Study

Abstract

Background: The role of statins among patients with established cardiovascular diseases (CVDs) who are hospitalized with COVID-19 is still debated. This study aimed at assessing whether the prior use of statins was associated with a less severe COVID-19 prognosis.

Methods: Subjects with CVDs infected with SARS-CoV-2 and hospitalized between 20 February 2020 and 31 December 2020 were selected. These were classified into two mutually exclusive groups: statins-users and non-users of lipid-lowering therapies (non-LLT users). The relationship between statins exposure and the risk of Mechanical Ventilation (MV), Intensive Care Unit (ICU) access and death were evaluated by using logistic and Cox regressions models.

Results: Of 1127 selected patients, 571 were statins-users whereas 556 were non-LLT users. The previous use of statins was not associated with a variation in the risk of need of MV (Odds Ratio [OR]: 1.00; 95% Confidence Intervals [CI]: 0.38-2.67), ICU access (OR: 0.54; 95% CI: 0.22-1.32) and mortality at 14 days (Hazard Ratio [HR]: 0.42; 95% CI: 0.16-1.10). However, a decreased risk of mortality at 30 days (HR: 0.39; 95% CI: 0.18-0.85) was observed in statins-users compared with non-LLT users.

Conclusions: These findings support the clinical advice for patients CVDs to continue their treatment with statins during SARS-CoV-2 infection.

Keywords: COVID-19; ICU access; mechanical ventilation; mortality; pharmacoepidemiology; public health; statins.

Figure 1

Study cohorts’ selection. LLTs: Lipid-lowering therapies.

Figure 2

Subgroup and adherence analyses of ICU access risk (A), need of mechanical ventilation risk (B) and 14day (C) and 30-day (D) all-cause mortality in CVDs patients that tested positive for SARS-CoV-2 and were hospitalized. Legend: For anticoagulant-use group in panel (C) and ≤65 years group in (C,D), the estimation was not allowed due to absence of data.