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Statin use linked to lower death rate in COVID-19

Statin use is associated with lower death rate among Swedish patients infected with COVID-19 according to a large registry study.

The use of statin drugs seems to be associated with a lower mortality in those infected with COVID-19. This was the finding of an analysis of data in a large, Swedish cohort study. In the past, studies on the relationship between statin use and mortality have been conflicting. For example, a Danish observational study concluded that “recent statin exposure in patients with COVID-19 infection was not associated with an increased or decreased risk of all-cause mortality or severe infection.” In contrast, however, a US study observed a greater than 50% reduction in the risk of developing severe COVID-19 in those taking statin drugs, after controlling for co-morbidities and other treatments. Although a meta-analysis of studies on the use of statins and outcomes for COVID-19, concluded that the drug class was not associated with an improvement in a composite of poor outcomes, there was substantial heterogeneity with the included studies. With some on-going trials examining the adjunctive value of statins, more definitive answers are likely to emerge over the coming months and provide some much needed clarity of the possible benefit of this class of medicine. However, while the world awaits the results of these trials, a team from the Department of Global Public Health, Karolinska Institute, Stockholm, Sweden have published the results of a large population-based observational study, examining the relationship between statin use and COVID-19 mortality.

The researchers used a prescribed drug registry and included individuals aged 45 years and older who were prescribed any type of statin between March 2019 and the end of February 2020. These individuals were followed-up until death from either COVID-19 or any other cause. For their study, the primary outcome of interest was death from COVID-19 and the analysis was presented as adjusted hazard ratios. Adjustments were made for numerous factors including age, gender, income, household crowding and wide range of co-morbidities.

Findings

The analysis included 963,876 individuals which comprised 169, 642 statin users with a median age of 71 years (43.4% female) with hypertension being the most common co-morbidity (74.3%). Overall, 2,545 individuals died from COVID-19 during the period of follow-up; 756 (0.5%) who were statin users, giving an adjusted hazard ratio for mortality of 0.88 (95% CI 0.79 – 0.97, p = 0.01) compared to non-statin users. This association did not differ by gender (p = 0.65), across age groups (p = 0.82) or COVID-19 risk groups (p  = 0.72).

While these data are based on an association and hence it is unclear whether there is a causal relationship between statin use and mortality, the findings do offer some tentative clues that individuals using these drugs appear less likely to die from infection with the virus. The authors concluded that the results provide some support for the continued use of statins during the COVID-19 pandemic.

Citation

Bergqvist R et al. HMG-CoA reductase inhibitors and COVID-19 mortality in Stockholm, Sweden: A registry- based cohort study. PLoS Med 2021



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