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Statin use and clinical outcomes in patients with COVID-19: An updated systematic review and meta-analysis
Rimesh Pal1, Mainak Banerjee2, Urmila Yadav3
1Endocrinology, Post Graduate Institute of Medical Education and Research, Chandigarh, Chandigarh, India rimesh.ben@gmail.com.
Insights
Statin use in COVID-19 patients was linked to better outcomes in adjusted analyses, despite initial unadjusted data showing no effect. Continue statin therapy, especially for those with comorbidities, during the pandemic.
Area of Science:
- Cardiology
- Infectious Diseases
- Pharmacology
Background:
- Observational studies suggest statins may reduce adverse outcomes in COVID-19 patients.
- Existing data are limited, inconsistent, and lack randomized controlled trials.
- A comprehensive meta-analysis is needed to clarify the effect of statins on COVID-19 outcomes.
Purpose of the Study:
- To conduct a meta-analysis of observational studies to summarize the effect of statin use on clinical outcomes in COVID-19 patients.
- To evaluate both unadjusted and adjusted risk estimates for statin use in COVID-19.
- To provide an updated summary of evidence regarding statins and COVID-19 outcomes.
Main Methods:
- Systematic search of PubMed, Scopus, and Web of Science databases up to December 18, 2020.
- Inclusion of observational studies comparing COVID-19 patients with and without statin use (prior and in-hospital).
- Quality assessment using the Newcastle-Ottawa Scale and calculation of pooled odds ratios (OR) with 95% confidence intervals (CIs).
Main Results:
- 14 observational studies with 19,988 COVID-19 patients were included; all were of high/moderate quality.
- Unadjusted analysis showed no significant association between statin use and improved outcomes (OR 1.02, p=0.94).
- Adjusted analysis revealed a significant reduction in adverse outcomes with statin use (OR 0.51, p<0.0005).
Conclusions:
- Statin use is associated with improved clinical outcomes in patients with COVID-19.
- The findings support the continuation of statin therapy for individuals with comorbidities during the pandemic.
- Further research, including randomized controlled trials, may be warranted to confirm these findings.
Purpose:
Observations studies have shown that prior use of statins is associated with a reduced risk of adverse clinical outcomes in patients with COVID-19. However, the available data are limited, inconsistent and conflicting. Besides, no randomised controlled trial exists in this regard. Hence, the present meta-analysis was conducted to provide an updated summary and collate the effect of statin use on clinical outcomes in COVID-19 using unadjusted and adjusted risk estimates.
Methods:
PubMed, Scopus and Web of Science databases were systematically searched using appropriate keywords till December 18 2020, to identify observational studies reporting clinical outcomes in COVID-19 patients using statins versus those not using statins. Prior and in-hospital use of statins were considered. Study quality was assessed using the Newcastle-Ottawa Scale. Unadjusted and adjusted pooled odds ratio (OR) with 95% CIs were calculated.
Results:
We included 14 observational studies pooling data retrieved from 19 988 patients with COVID-19. All the studies were of high/moderate quality. Pooled analysis of unadjusted data showed that statin use was not associated with improved clinical outcomes (OR 1.02; 95% CI 0.69 to 1.50, p=0.94, I2=94%, random-effects model). However, on pooling adjusted risk estimates, the use of statin was found to significantly reduce the risk of adverse outcomes (OR 0.51; 95% CI 0.41 to 0.63, p<0.0005, I2=0%, fixed-effects model).
Conclusions:
Statin use is associated with improved clinical outcomes in patients with COVID-19. Individuals with multiple comorbidities on statin therapy should be encouraged to continue the drug amid the ongoing pandemic.
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