Large study finds lower risk of death from COVID-19 in statin users - Medical News Today

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New research finds that statins may have a moderately protective effect against the risk of death from COVID-19. gece33/Getty Images

• Researchers have investigated the link between statin use and COVID-19 mortality in around 1 million people.
• They found that statin use was associated with a slightly lower risk of COVID-19 mortality, regardless of age, sex, and COVID-19 risk factors.
• The team notes that further research is needed to confirm whether statins protect against COVID-19; however, those prescribed statins should continue taking their medication.

Statins are a group of drugs used to reduce levels of low-density lipoprotein (LDL) cholesterol in the blood, also known as "bad" cholesterol.

Having high LDL cholesterol levels can lead to the hardening and narrowing of arteries and cardiovascular disease. Around 40 million people in the United States use statins to manage their cholesterol levels.

Cardiovascular disease and high cholesterol levels have been linked to worsened COVID-19 outcomes. Meanwhile, other research has suggested that statins may have antiviral, anti-inflammatory, and anti-clotting effects that may be beneficial against COVID-19.

This spring, a study that included 648 patients hospitalized with COVID-19 found that participants who took statins before developing COVID-19 were around 50% less likely to die in the hospital than those who did not.

Until now, there has been little research on how statin use affects COVID-19 outcomes outside of hospital settings.

Recently, researchers from Sweden and Australia conducted a large population study of almost 1 million people, exploring the relationship between statins and COVID-19 mortality. They found that statin use was associated with a slightly lower risk of dying from the disease.

"The results were in line with our hypothesis, and some previous observational studies have shown similar results," Rita Bergqvist, co-first author of the study and a medical student at the Karolinska Institutet, in Solna, Sweden, told Medical News Today.

"Still, we're happy that we have been able to provide additional, scientifically robust support for the current recommendations to continue statin treatment during the pandemic," she added.

The study paper has been published in PLOS Medicine.

The researchers gathered data on people in the Stockholm area of Sweden from various public registries, including the Swedish Prescribed Drug Register and the Swedish Cause of Death Registry.

The data included information about education and income levels, as well as information from hospitals and outpatient clinics about preexisting conditions, according to the International Classification of Diseases, collected prescriptions, and COVID-19 related deaths.

The team included individuals aged 45 and older who resided in Stockholm county both in 2019 and on March 1, 2020. Altogether, they examined data from 963, 876 people and followed their health outcomes until November 11, 2020.

Of those studied, 51.6% were female, and 17.6% had collected at least one prescription for statins in the year before the pandemic began. Those who took statins tended to be older than those who did not. They also tended to have more comorbidities, such as ischemic heart disease, heart failure, and hypertension.

Of the 2,545 individuals who had died from COVID-19 by the follow-up, 765 had taken statins while 1,780 had not. This means that 0.5% of those who took statins and 0.2% of those who did not died from the disease. "However," the authors explain, "when adjusting for confounders, statin treatment was associated with a moderately lower risk of COVID-19 mortality."

This moderately lower risk was significant regardless of age, sex, and general COVID-19 risk.

Severe COVID-19 is a result of inflammatory and immune reactions to SARS-CoV-2, the underlying virus. It is thus possible that statins' anti-inflammatory effects and ability to modulate the immune response may have a positive effect on a person with COVID-19, although the exact mechanisms are still unknown.

"It's important to remember that our study shows there's a possibility that there is a moderate protective effect of statins against COVID-19. But to be sure of a protective effect, we would need a randomized controlled trial," Bergqvist said. "There is always a possibility that the results of an observational study like ours are due to unknown factors that we haven't been able to adjust for in our models."

"Moreover, pharmacological mechanisms are beyond the scope of epidemiological studies. Pleiotropic effects of statins, including immune modulation and decreased risk of thrombosis, have been discussed for a number of years," she added.

"We know that cardiovascular morbidity is a risk factor for severe COVID-19 [and] COVID-19 death, and we also know that statins prevent cardiovascular morbidity in high-risk groups," she explained.

The researchers concluded that statins have a modest association with reduced COVID-19 mortality and that their findings support the continued use of statins as a preventive measure, according to current guidelines.

One limitation of the study is that its findings are based on registry data, and thus, knowing whether people took the drugs as prescribed is unknown. And while the researchers considered various factors that might account for their results, other unknown factors could be at play.

"This is an observational study, which means that the association between statin use and improved COVID-19 outcomes could be a result of another factor that the authors were unable to capture and adjust for in their analyses. For instance, they did not have the body mass index or smoking status of patients," Dr. Monica Gandhi, a professor of clinical medicine at the University of California, San Francisco, who not involved in the study, told MNT.

"In addition, just getting a statin prescription, which is how they measured use, is not consistently associated with medication consumption, and there was no way to measure adherence to the medication. On the other hand, their methods were sophisticated and the findings important," Dr. Gandhi added.

"The clinical implications of these findings are that statins should not be stopped during COVID-19 or upon hospitalization, as [they are] likely helping the course. I would have a low threshold to start statins for hypercholesterolemia [high levels of cholesterol in the bloodstream] during the pandemic, knowing the favorable response."

"But I don't think this observational study can tell us whether it is prudent to start a statin if not otherwise medically indicated to try to impact COVID-19 outcomes," Dr. Gandhi cautioned.

When asked about the study's main takeaway, Bergqvist said: "Our main message is: Keep taking your statins! Statin treatment reduces the risk of cardiovascular events in high risk groups, for example, individuals who have had a stroke or suffer from angina. The possible effect on COVID-19 is an added bonus."

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