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Pros and cons for use of statins in people with coronavirus disease-19 (COVID-19)
Ray Subir1, Mukherjee Jagat J1, Gangopadhyay Kalyan K2
1Department of Endocrinology and Diabetes, Apollo Gleneagles Hospitals, Kolkata, India.
Insights
Continue statin therapy for COVID-19 patients with existing conditions like diabetes and cardiovascular disease. New statin use in COVID-19 patients may offer benefits but requires further clinical trial validation.
Area of Science:
- Cardiovascular Medicine
- Infectious Diseases
- Pharmacology
Background:
- Diabetes Mellitus (DM), hypertension, and cardiovascular disease (CVD) increase COVID-19 morbidity and mortality.
- Statins are commonly prescribed for DM and CVD patients.
- Understanding the benefit-risk ratio of statins in COVID-19 is crucial.
Purpose of the Study:
- To review the current understanding of the benefit-risk ratio of statin use in COVID-19.
- To evaluate the potential benefits and risks of statins for COVID-19 patients.
Main Methods:
- A literature search was conducted on the PubMed database.
- Relevant articles published in English were retrieved and reviewed up to June 12, 2020.
Main Results:
- Statins possess immunomodulatory, anti-inflammatory, anti-thrombotic, and anti-oxidant properties that may reduce COVID-19 severity and mortality.
- Statin-induced ACE2 upregulation may mitigate lung injury, and lipid raft disruption could inhibit viral entry.
- Further research is needed on statin interactions with MYD88 gene expression and the role of low LDL cholesterol in COVID-19 outcomes.
Conclusions:
- COVID-19 patients on statins for comorbidities should continue therapy unless contraindicated.
- De novo statin use in COVID-19 patients without comorbidities may be beneficial but requires clinical trial substantiation.
- Until then, de novo statin use in COVID-19 should be confined to clinical trials.
Background And Aims:
Morbidity and mortality from coronavirus disease 2019 (COVID-19) is higher among people with diabetes mellitus (DM), hypertension, and cardiovascular disease (CVD). Statins are used in the majority of people with DM and CVD. This mini-review discusses the current understanding of benefit-risk ratio of use of statins in COVID-19.
Methods:
We searched PubMed database using specific keywords related to our aims till June 12, 2020. Full text of relevant articles published in English language were retrieved and reviewed.
Results:
Statins, with their immunomodulatory, anti-inflammatory, anti-thrombotic, and anti-oxidant properties, have the potential to reduce severity of lung injury in, and mortality from, severe acute respiratory syndrome-coronavirus 2 (SARS-CoV2) infections. Statin-induced upregulation of angiotensin-converting enzyme-2 (ACE2) has the potential to reduce lung injury from excess angiotensin II. By disrupting lipid rafts, statins have the potential to reduce viral entry into cells. However, benefit-risk ratio of its complex interaction with MYD88 gene expression on outcomes in COVID-19, and the putative role of low serum LDL cholesterol in increasing severity of SARS-CoV2 infection need further clarification.
Conclusions:
People with COVID-19, who are already on statins for an underlying co-morbid condition, should continue on it unless there are specific contraindications. De-novo use of statins in people with COVID-19 with no underlying co-morbidity might be beneficial but awaits substantiation in clinical trials; till that time, de novo use of statins in COVID 19 should be limited to a clinical trial setting.
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