26 Sep Patients on Statins Less Likely to Develop Severe COVID-19 Infections

MedicalResearch.com Interview with:

Dr. Daniels

Lori B. Daniels, MD, MAS, FACC, FAHA
Professor of Medicine
Director, Cardiovascular Intensive Care Unit
UCSD Division of Cardiovascular Medicine
Sulpizio Cardiovascular Center
La Jolla, CA 92037-7411 

MedicalResearch.com: What is the background for this study?

Response: The purpose of our study was to investigate whether there is an association between the use of statin medications and COVID-19 morbidity and mortality among patients hospitalized for COVID-19. Our study investigated all patients hospitalized for treatment of COVID at a major US academic medical center during the study period. We studied patients who were hospitalized with COVID-19, and compared those who had been taking statins for at least 30 days prior to admission, with those not on statins. 

MedicalResearch.com: What are the main findings? 

Response: Our main findings are that patients taking statins were less likely to develop severe COVID-19, which was defined as the need intubation (breathing machine/ventilator), care in the ICU (intensive care unit), or death, than those not on statins. Statin users also had a faster time to recovery than patients not on statins.

MedicalResearch.com: Why do these results matter for clinical care and patient outcomes?

Response: These results matter because since the outset of COVID, there has been a lot of speculation in the medical community about whether various cardiovascular medications – including statins, ACE inhibitors, and ARBs in particular – might be harmful.  Because these medications have effects on the receptor that the coronavirus (SARS-CoV2) uses to enter the body, there was concern that these medications might increase susceptibility to COVID, or severity of disease.  Patients with heart disease, diabetes, and hypertension are commonly on these classes of medications, and also have been noted to be at increased susceptibility to COVID, so the question is an important one for millions of people.  Importantly, these medications are also life-saving for people with cardiovascular disease.  Therefore, the fact that statins are NOT associated with harm, and may in fact have protective effects, is reassuring and should help physicians and patients feel very comfortable in continuing these medications. Statins are safe in the setting of COVID-19, and may even be helpful. 

MedicalResearch.com: Can we be certain that stain use is associated with a lower risk of severe COVID and a faster recovery? Are these effects due to the medication itself or are people who take statin and have lower healthier than people with higher cholesterol?

Response: Since this was an observational study, we cannot say for certain that the benefits seen were due to the statin itself. However, the benefits associated with statin (reduced likelihood of severe infection and faster time to recovery from severe infection) use were apparent even after we accounted for the presence or absence of heart disease, hypertension and other underlying medical conditions. In addition, we looked at a comparison population of patients hospitalized for reasons other than COVID during the same dates. One might expect that patients on statins would do better than comparable patients not on statins, as they might be people who tend to see doctors and have healthier habits, and we did find a protective effect associated with statin use among these non-COVID patients also. However, we found that the protective effect of statins was significantly stronger in patients hospitalized with COVID than in the comparison population of other patients, suggesting that there is likely some “extra” benefit that statins provide in the setting of COVID infection. 

MedicalResearch.com: What are the main limitations of this study and why?

Response: The main limitation is that this is an observational study, which means that there may be factors other than the statin itself – but related to statin use – that caused this protective effect.   Observational studies cannot account for all of these potential biases or confounding factors, even though we tried to account for the main/obvious ones.  Only a randomized trial can eliminate all of the unmeasured confounding factors, but observational studies can provide a good, solid base of evidence upon which to design future randomized trials.  Also, this was a single center study with a relatively small sample size. We are currently working to replicate these analyses in a much larger study sample, from many sites across the US.

MedicalResearch.com: What are some strengths of this study?

Response: A strength of our study is that we had access to the entire electronic medical record for these patients, and we then did extensive manual verification of the data. The resulting rich, high quality data meant that we were able to adjust for multiple potential confounders such as other medical conditions or other medications being taken. We also were able to compare our results to the COVID-negative hospitalized population from the same time period, to help us assess for bias and confounding.

MedicalResearch.com: What’s the take-home message for clinicians here? What do these results tell us about optimal clinical care? To what extent do these results suggest that doctors might want to prescribe statins even to people without high cholesterol, or to consider a lower threshold for stain treatment, or consider statin therapy even after patients with previously high cholesterol lower it to a healthy range?  

Response: The take-home message is that statin use does not appear to be harmful, and may be protective, in the setting of COVID-19 infection.  These data should reassure patients and physicians that continuing statins during this pandemic is safe.  We do not yet have sufficient data to suggest that doctors should start prescribing statins to people without an indication for them; however for those individuals who have been prescribed a statin in the past (or who have an indication) but were on the fence about it or reluctant to take it for any reason –  these data may tip the balance in favor of taking the medication. 

Citation 

1. Lori B. Daniels, Amy M. Sitapati, Jing Zhang, Jingjing Zou, Quan M. Bui, Junting Ren, Christopher A. Longhurst, Michael H. Criqui, Karen Messer. Relation of Statin Use Prior to Admission to Severity and Recovery Among COVID-19 Inpatients. The American Journal of Cardiology, 2020; DOI: 1016/j.amjcard.2020.09.012
2. Shaobo Wang, Wanyu Li, Hui Hui, Shashi Kant Tiwari, Qiong Zhang, Ben A. Croker, Stephen Rawlings, Davey Smith, Aaron F. Carlin, Tariq M. Rana. Cholesterol 25‐Hydroxylase inhibits SARS‐CoV‐2 and coronaviruses by depleting membrane cholesterol. The EMBO Journal, 2020; DOI: 15252/embj.2020106057

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Last Updated on September 26, 2020 by Marie Benz MD FAAD