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Statin use and severe, critical, or fatal outcomes among individuals with coronavirus disease 2019
Adeel A Butt1,2,3, Peng Yan1, Obaid S Shaikh1,4
1VA Pittsburgh Healthcare System and Veterans Health Foundation, Pittsburgh, PA, USA.
Insights
Statin use in patients with coronavirus disease 2019 (COVID-19) did not reduce overall disease severity. However, benefits were observed in specific subgroups, suggesting statins may impact underlying conditions rather than the acute infection.
Area of Science:
- Cardiovascular Medicine
- Infectious Diseases
- Pharmacology
Background:
- The role of statins in coronavirus disease 2019 (COVID-19) remains controversial.
- Statins are commonly prescribed for cardiovascular conditions and have anti-inflammatory properties.
Purpose of the Study:
- To investigate the association between statin use and severe, critical, or fatal outcomes in patients diagnosed with COVID-19.
- To identify potential subgroup differences in the effect of statins on COVID-19 severity.
Main Methods:
- A retrospective cohort study using the US Department of Veterans Affairs COVID-19 database.
- Identified statin users and created a weighted cohort of statin non-users using inverse probability of treatment weighting.
- Primary outcome was severe, critical, or fatal COVID-19 within 28 days of diagnosis.
Main Results:
- Overall, statin use was not associated with a reduction in severe, critical, or fatal COVID-19.
- Subgroup analyses indicated potential benefits in individuals over 60, White individuals, and those with diabetes, coronary artery disease, stroke, chronic lung disease, or chronic kidney disease.
- When prevalent cardiovascular disease was excluded, the association shifted towards favoring statin non-users.
Conclusions:
- Statin users with COVID-19 did not demonstrate a reduced risk of severe disease.
- Observed favorable outcomes in certain subgroups may be attributed to the management of underlying conditions by statins, rather than a direct effect on COVID-19 severity.
Objectives:
The role of statins in coronavirus disease 2019 (COVID-19) is controversial. We sought to determine the association between statin use and severe/critical/fatal disease in individuals with COVID-19.
Methods:
Using the US Department of Veterans Affairs COVID-19 database, we identified statin users with COVID-19 and inverse probability of treatment-weighted statin non-users. The primary outcome was severe, critical, or fatal disease within 28 days of diagnosis.
Results:
Among 8394 statin users and 59,412 inverse probability of treatment-weighted non-users, 277 statin users (3.3%) and 1493 non-users (2.5%) developed severe, critical, or fatal disease (absolute risk difference [ARD], -0.02; 95% confidence interval [CI], -0.19 to 0.16). Statin use was associated with more favorable outcomes among individuals aged >60 years (ARD, -0.79; 95% CI, -1.10 to -0.48), White individuals (ARD, -0.30; 95% CI, -0.51 to -0.09), and those with diabetes mellitus (ARD, -1.36; 95% CI, -1.82 to -0.90), coronary artery disease (ARD, -1.10; 95% CI, -1.89 to -0.31), stroke (ARD, -2.10; 95% CI, -3.65 to -0.55), chronic lung disease (ARD, -1.31; 95% CI, -1.94 to -0.68), chronic kidney disease (ARD, -2.46; 95% CI, -3.38 to -1.54), receipt of a booster vaccine dose (ARD, -0.34; 95% CI, -0.57 to -0.10), or no symptoms (ARD, -0.36; 95% CI, -0.59 to -0.14). After individuals with prevalent CVD were excluded, the nonsignificant association shifted toward favoring statin non-users (ARD, 0.62; 95% CI, 0.34-0.90).
Conclusion:
Statin users with COVID-19 did not experience a reduction in disease severity. In certain subgroups, favorable outcomes appeared to be related to the effects of statins on underlying disease processes.
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