Investigating Lipid-Modulating Agents for Prevention or Treatment of COVID-19: JACC State-of-the-Art Review

Talasaz, Azita H.; Sadeghipour, Parham; Aghakouchakzadeh, Maryam; Dreyfus, Isaac; Kakavand, Hessam; Ariannejad, Hamid; Gupta, Aakriti; Madhavan, Mahesh V.; Van Tassell, Benjamin W.; Jimenez, David; Monreal, Manuel; Vaduganathan, Muthiah; Fanikos, John; Dixon, Dave L.; Piazza, Gregory; Parikh, Sahil A.; Bhatt, Deepak L.; Lip, Gregory Y.H.; Stone, Gregg W.; Krumholz, Harlan M.; Libby, Peter; Goldhaber, Samuel Z.; Bikdeli, Behnood

Coronavirus disease-2019 (COVID-19) is associated with systemic inflammation, endothelial activation, and multiorgan manifestations. Lipid-modulating agents may be useful in treating patients with COVID-19. These agents may inhibit viral entry by lipid raft disruption or ameliorate the inflammatory response and endothelial activation. In addition, dyslipidemia with lower high-density lipoprotein cholesterol and higher triglyceride levels portend worse outcomes in patients with COVID-19. Upon a systematic search, 40 randomized controlled trials (RCTs) with lipid-modulating agents were identified, including 17 statin trials, 14 omega-3 fatty acids RCTs, 3 fibrate RCTs, 5 niacin RCTs, and 1 dalcetrapib RCT for the management or prevention of COVID-19. From these 40 RCTs, only 2 have reported preliminary results, and most others are ongoing. This paper summarizes the ongoing or completed RCTs of lipid-modulating agents in COVID-19 and the implications of these trials for patient management.