Statins and clinical outcomes with COVID-19: Meta-analyses of observational studies

COVID-19; Intensive care unit; Mortality; SARS-CoV-2; Statin; Type 2 diabetes; angiotensin converting enzyme 2; hydroxymethylglutaryl coenzyme A reductase inhibitor; adult; adult respiratory distress syndrome; aged; all cause mortality; Article; cardiovascular disease; clinical outcome; cohort analysis; comorbidity; coronavirus disease 2019; diabetes mellitus; diabetic patient; disease burden; disease severity; endotracheal intubation; female; hospital admission; hospital mortality; human; hypertension; intensive care unit; male; meta analysis; middle aged; mortality rate; Severe acute respiratory syndrome coronavirus 2; systematic review; mortality; observational study; retrospective study; severity of illness index; treatment outcome; Diabetes Mellitus; Hospital Mortality; Humans; Hydroxymethylglutaryl-CoA Reductase Inhibitors; Observational Studies as Topic; Retrospective Studies; Severity of Illness Index; Treatment Outcome

Abstract :

[en] Aims: People with cardiovascular disease or risk factors are at increased risk when exposed to SARS-CoV-2. Most are treated with statins, but the impact of these drugs on clinical outcomes of COVID-19 remains unclear. This report is therefore based on meta-analyses of retrospective observational studies aimed at investigating the impact of previous statin therapy in patients hospitalized for COVID-19. Methods: In studies reporting on the clinical outcomes of COVID-19 in statin users vs non-users, two endpoints have been used—in-hospital death rates, and disease severity as assessed by admission to intensive care units (ICUs)—with a special focus on patients with diabetes. Results: Regarding mortality, 13 studies were included in the meta-analysis for a total of 10,829 statin users (2517 deaths) and 31,893 non-users (7516 deaths): univariate analysis showed no statistically significant reduction in deaths (OR: 0.97, 95% CI: 0.92–1.03), although between-study heterogeneity was high (I² = 97%). As for disease severity, 11 studies were selected for a total of 3462 statin users (724 endpoints) and 10,560 non-users (1763 endpoints): here again, univariate analysis showed no reduction in severity (OR: 1.09, 95% CI: 0.99–1.22; I² = 93%). Collectively, in 10 studies using multivariable analysis adjusted for the more prevalent baseline risk factors among statin users, lower OR values were reported than with univariate analyses (0.73 ± 0.31 vs 1.44 ± 0.84, respectively; P = 0.0028; adjusted OR: P = 0.0237 vs non-users). Limited but conflicting findings were observed for diabetes patients. Conclusion: Although no significant reductions in either in-hospital mortality or COVID-19 severity were reported among statin users compared with non-users after univariate comparisons, such reductions were observed after adjusting for confounding factors. These highly heterogeneous observational findings now require confirmation by ongoing randomized clinical trials. © 2020 Elsevier Masson SAS

Disciplines :

Endocrinology, metabolism & nutrition
Pharmacy, pharmacology & toxicology

Author, co-author :

Scheen, André ; Centre Hospitalier Universitaire de Liège - CHU > > Service de diabétologie, nutrition, maladies métaboliques

Language :

English

Title :

Statins and clinical outcomes with COVID-19: Meta-analyses of observational studies

Publication date :

2021

Journal title :

Diabetes and Metabolism

ISSN :

1262-3636

eISSN :

1878-1780

Publisher :

Elsevier Masson s.r.l.

Volume :

Issue :

Peer reviewed :

Peer Reviewed verified by ORBi

Available on ORBi :

since 23 February 2023

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