Comparing incidence and severity of COVID-19 between statin users and non-users

1. Comparing statin and non statin using patients, there is no difference in rates of positive COVID-19 test result.

2. For patients under the age of 75, statin use is not associated with differences in emergency department visits, hospitalizations, and 30-day all-cause mortality following a positive test result.

3. For patients over 75, emergency department visits and hospitalizations were higher than in non-statin using patients, but 30-day all-cause mortality was lower.

Evidence Rating Level: 2 (Good)

Numerous chronic conditions, such as diabetes mellitus and chronic kidney disease, are not only risk factors for SARS-CoV-2 infection, but are also associated with worse outcomes. Although the association between COVID-19 morbidity and chronic medication use is unknown, a meta-analysis found that statin-using patients with COVID-19 infection had a 46% lower risk of death. However, a meta-analysis of statin treatment in patients with non-COVID-19 infections found no difference in 28-day hospital mortality. Therefore, the current observational study based in Alberta and Ontario, Canada, aimed to determine the association between statin use and COVID-19 infection rates, as well as morbidity and mortality. This involved identifying all adults with an RT-PCR swab test between January and June 2020. In total, there were 115,871 statin users and 353,878 statin nonusers identified, with statin users being more likely to test positive (3.6% versus 2.8%, p < 0.001), although this was not significant after adjusting for statin use by age. As well, for patients under the age of 75, statin users had a greater  likelihood of visiting the emergency department (ED), being admitted to the ICU, or dying of any cause within 30 days of their positive result, although these differences were not significant after adjusting for patients’ propensity for statin use. For patients over 75, statin users were also more likely to visit the ED (28.2% versus 17.9%, adjusted odds ratio 1.41 [95% CI 1.23-1.61]) and be hospitalized (32.7% versus 21.9%, aOR 1.19 [95% CI 1.05-1.36]), but had lower all-cause mortality within 30 days of their positive result (26.9% versus 31.3%, aOR 0.76 [95% CI 0.67-0.86]). Overall, this study found that statin use did not worsen or improve outcomes for patients infected with COVID-19. In the over 75 population where statin use was associated with improved mortality, randomized controlled trials would be needed to further explore and substantiate this association.

Click to read the study in JAHA

Image: PD

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