Prior Statins Use and Risk of Mortality and Severe Disease from COVID-19: A Systematic Review and Meta-Analysis

Yetmar, Zachary A; Chesdachai, Supavit; Kashour, Tarek; Riaz, Muhammad; Gerberi, Danielle J; Badley, Andrew D; Berbari, Elie F; Tleyjeh, Imad M

BACKGROUND: Statins up-regulate angiotensin converting enzyme-2, the receptor of SARS-CoV-2, while also exhibiting pleiotropic antiviral, antithrombotic and anti-inflammatory properties. Uncertainties exist about their effect on the course of SARS-CoV-2 infection. OBJECTIVES: We sought to systematically review the literature and perform a meta-analysis to examine the association between prior statins use and outcomes of patients with COVID-19. METHODS: We searched Ovid MEDLINE, Web of Science, Scopus, and the preprint server MedRxiv from inception to December 2020. We assessed the quality of eligible studies with the Newcastle-Ottawa quality scale. We pooled adjusted risk ratios (aRR) of the association between prior statins use and outcomes of patients with COVID-19 using the DerSimonian-Laird random effects model and assessed heterogeneity using the I (2)-index. RESULTS: Overall, 19 (16 cohorts and 3 case-control) studies were eligible, with a total of 395,513 patients. Sixteen of 19 studies had low- or moderate-risk of bias. Among 109,080 patients enrolled in 13 separate studies, prior statins use was associated with a lower risk of mortality, (pooled aRR 0.65 (95% CI 0.56-0.77, I (2) = 84.1%) and a reduced risk of severe COVID-19 was also observed in 48,110 patients enrolled in 9 studies, (pooled aRR of 0.73 (95% CI 0.57-0.94, I (2) = 82.8%), with no evidence of publication bias. CONCLUSIONS: Cumulative evidence suggests that prior statins use is associated with lower risks of mortality or severe disease in patients with COVID-19. These data support the continued use of statins medications in patients with an indication for lipid-lowering therapy during the COVID-19 pandemic.