Statin use leads to a significantly reduced risk of COVID-19 related hospitalisation and death according to a large propensity matched study
Statin use for the primary prevention of cardiovascular disease is associated with a significant reduction in the risk of both hospitalisation and mortality in those with COVID-19 according to the results of a large, propensity-matched analysis of the French National Healthcare database by a team from the French National Agency for Medicines and Health Products Safety, Paris, France.
Prior to the introduction of COVID-19 vaccines, drug repurposing was examined as a potential means for reducing the severity of infection and one class of drugs examined were the statins. There is a sound rational for considering this class of drugs as a treatment for viral infections. For instance, it has been found that in patients hospitalised with laboratory-confirmed seasonal influenza, statin treatment is associated with a 41% reduction in 30-day mortality. It has also been shown that cells treated with statins produced Ebola virus particles devoid of the surface glycoproteins required for virus infectivity.
Some studies have already demonstrated that there is a statistically significant decrease in the odds of in-hospital mortality in patients with COVID-19 prescribed statins before admission. However, this is not a universal finding and other data has suggested that the use of statins (in patients with type 2 diabetes) is associated with increased mortality among those hospitalised with COVID-19. For the present study, the French team examined the relationship between the use of this drug class and symptomatic COVID-19 that led to hospitalisation. Using the French National Healthcare database, they identified patients aged 40 years and older, prescribed one of several statins (the exposed group) and propensity-matched these individuals based on age, gender, co-morbidities and sociodemographic factors (control group). The researchers also assessed the relationship between the type of statin and intensity of therapy (e.g., low, moderate or high) and COVID-related hospitalisation. The primary outcome was COVID-19-related hospitalisation and using Cox proportion hazard models, adjusted for several covariates e.g., age, gender, co-morbidities, the researchers calculated event rates between those using statins and the matched-control patients.
Statin use and COVID-19 hospitalisation
A total of 2,058249 patients with a mean age 68.7 years (46.6% male) taking statins matched with the same of control patients. The most common co-morbidities were hypertension (41.8%) and diabetes (33.7%). There were a total of 9,396 hospitalisations for COVID-19, 4372 among those in the control group.
In fully adjusted models, patients in the statin group had a 16% reduced risk of hospitalisation (hazard ratio, HR = 0.84, 95% CI 0.81 – 0.88, p < 0.0001). This relationship was maintained for the different agents within the class. For example, the risk was reduced by 25% for fluvastatin (HR = 0.75) and simvastatin (HR = 0.79). The relationship was also significant for low (e.g. fluvastatin 20/40 mg), medium (e.g., simvastatin 10 mg), not not for high (e.g., atorvastatin 40 or 80 mg) intensity therapy.
A similar reduction in risk was also evident for mortality among those taking statins (HR = 0.77, 95% CI 0.69 – 0.86). However, both atorvastatin and fluvastatin did not have a significant effect on mortality and as with hospitalisation, there was no significant effect for high intensity therapy on mortality.
The authors concluded that their data suggested a relatively small, but robust reduction in the risk of COVID-19-related hospitalisation and death among those prescribed statins before hospital admission.
Bouillon K et al. Association of Statins for Primary Prevention of Cardiovascular Diseases With Hospitalization for COVID‐19: A Nationwide Matched Population‐Based Cohort Study J Am Heart Assoc 2022