BACKGROUND: The efficacy and safety of adjunctive statin therapy in hospitalized patients with coronavirus disease 2019 (Covid-19) remains uncertain.
METHODS: We systematically searched Medline, Embase, Cochrane, and ClinicalTrials.gov databases from inception to late April 2024 for randomized controlled trials (RCTs) comparing statin versus no statin use in patients hospitalized with Covid-19. We pooled risk ratios (RRs) and hazard ratios (HRs) with 95% confidence intervals (CIs) applying a random-effects model. R version 4.3.1 was used for statistical analyses.
RESULTS: We included 7 RCTs comprising 4,262 patients, of whom 2,645 (62%) were randomized to receive statin therapy. Compared with no statin, statin use significantly reduced case-fatality rate (RR 0.88; 95% CI 0.80-0.98; I2 = 0%). In a time-to-event analysis, we found similar results (HR 0.86; 95% CI 0.75-0.99; I2 = 0%). Statin use also significantly reduced World Health Organization (WHO) scale at 14 days (mean difference -0.27; 95% CI -0.54 to -0.01; I2 = 0%). There was no statistically significant difference between the two groups in length of hospital stay, elevation of liver enzymes, and C-reactive protein levels.
CONCLUSIONS: In patients hospitalized with Covid-19, statins significantly reduced case-fatality rate and WHO scale score.
REGISTRATION: A prospective register was recorded in International Prospective Register of Systematic Reviews (PROSPERO) with the number CRD42023479007.
| Discipline Area | Score |
|---|---|
| Infectious Disease |  |
| Hospital Doctor/Hospitalists |  |
| Internal Medicine | |
The finding on this meta-analysis suggests that administering statins to (assuming) inpatients has a significant mortality benefit. Although the individual studies did not show this finding, the rigorous Cochrane Collaboration Handbook methods for conducting meta-analysis did show a benefit. The theory is that the anti-inflammatory properties of statins can be protective in a COVID-19 infection. Given the paucity of side effects in these patients, it may be worthwhile considering administering statins for inpatients admitted for COVID-19. Interesting that we hold statins in our patients for whom we are giving Paxlovid.
It would be interesting to know whether the effects were different between those previously taking statins vs those who were not. Given that one-quarter of US adults are taking statins, it could well be that the satin-naive population could be somewhat more likely to be hospitalized. That would give credence to the cardiologists who have long said statins ought to be in the water supply.