Statin use and mortality in COVID-19 patients: Updated systematic review and meta-analysis

Background and aims: Statin therapy is administered to patients with high cardiovascular risk. These patients are
also at risk for severe course of coronavirus disease 2019 (COVID-19). Statins exhibit not only cardioprotective
but also immunomodulatory and anti-inflammatory effects. This study performed a systematic review of published
evidence regarding statin treatment and COVID-19 related mortality.
Methods: A systematic PubMed/Embase search was performed from February 10, 2020 until March 05, 2021 for
studies in COVID-19 patients that reported adjusted hazard or odds ratio for death in statin users versus nonusers.
Results: 22 studies fulfilled the inclusion criteria and were included in the systematic review. Meta-analysis of 10
studies (n = 41,807, weighted age 56 ± 8 years, men 51%, hypertension 34%, diabetes 21%, statin users 14%)
that reported adjusted hazard ratios for mortality in statin users versus non-users showed pooled estimate at 0.65
(95% confidence intervals [CI] 0.53, 0.81). Meta-analysis of 6 studies that reported continuation of statin therapy
during hospitalization (58–100% of patients) revealed a pooled hazard ratio of 0.54 (95% CI 0.47, 0.62). Metaanalysis
of 12 studies (n = 72,881, weighted age 65 ± 2 years, men 54%, hypertension 66%, diabetes 43%, statin
users 30%) that reported adjusted odds ratios for mortality showed pooled estimate at 0.65 (95% CI 0.55, 0.78).
Multivariable meta-regression analysis did not reveal any significant association of hazard or odds ratios with
anthropometric characteristics or comorbidities.
Conclusions: This meta-analysis of retrospective observational studies showed that statin therapy was associated
with an about 35% decrease in the adjusted risk of mortality in hospitalized COVID-19 patients.