Some 40 million people living in the United States take statins to help reduce their cholesterol levels and risk of heart disease.
That is why researchers are trying to figure out if statin use impacts COVID-19 outcomes.
In a new study, a group of researchers, including cardiologists caring for hospitalized COVID-19 patients in New York, set out to compare patient outcomes between people who had used statins before hospitalization and those who had not.
“Our study is one of the larger studies confirming this hypothesis, and the data lay the groundwork for future randomized clinical trials that are needed to confirm the benefit of statins in COVID-19,” says co-lead author of the study, Dr. Aakriti Gupta, MD, a cardiologist at NewYork-Presbyterian/Columbia University Irving Medical Center.
If a successful clinical trial validates the researchers’ findings, statins could represent a low-cost, easy to access, relatively safe treatment option for COVID-19.
Currently, the Food and Drug Administration (FDA) has approved only one drug to treat COVID-19 — remdesivir (Veklury). However, some other medications may be beneficial during certain stages of the disease.
The study appears in Nature Communications.
Statins are the most common type of drug that people use to lower cholesterol levels.
According to the American Heart Association, they work predominately by blocking a specific cholesterol-producing enzyme, causing less production and release of cholesterol.
Researchers have also been exploring whether statins can help treat viral infections that can lead to major complications, such as widespread inflammation, clotting, and associated cellular damage.
One of the most severe complications associated with COVID-19 and other respiratory infections is acute respiratory distress syndrome (ARDS). However, research evaluating the impact of statin usage on ARDS has not shown any large-scale benefits.
Despite this, a 2018 study found that statin use improved outcomes in people with a hyperinflammatory subtype of ARDS.
A 2017 study found that people taking statins on admission to the hospital for community-acquired pneumonia were less likely to die than people not taking them.
Researchers are now trying to assess whether statins could be useful in the context of COVID-19.
A 2020 study conducted in Singapore found that people taking statins were less likely to be admitted to the intensive care unit (ICU) than people not taking them.
Additional research found that people with COVID-19 who started taking statins after being hospitalized but who did not treatment in the ICU were 47% less likely to die.
Researchers in the U.S. also recently found that statin use before hospitalization may reduce the risk of developing severe COVID-19 by 50%.
The study also noted that people with COVID-19 who were taking statins before admission to the hospital saw improved recovery times.
Scientists think this might be because as well as reducing inflammation, the risk of clots, and cellular damage, statins also remove cholesterol from the outer membranes of cells.
SARS-CoV-2, the virus that causes COVID-19, binds and enters cells by attaching viral spike proteins to a cell’s angiotensin-converting enzyme 2 (ACE-2) receptors.
These receptors sit in a lipid raft, a part of the cell’s membrane that contains cholesterol, proteins like ACE-2, and other fats and proteins.
And studies show that removing cholesterol from these lipid rafts means that coronaviruses cannot enter cells, even after binding.
Statins and severe COVID-19 outcomes
In the new study, researchers compared outcomes in 648 patients with COVID-19 hospitalized during the first 18 weeks of the pandemic who normally used statins and 648 patients who did not.
They also matched patients in each group to reduce major differences in demographics, other medication use, and conditions that increase the risk of severe COVID-19.
Based on their analysis, in the study, 14.8% of people taking statins died in hospital within a month of being admitted versus 26.5% of patients not taking statins.
Once the researchers factored in major differences between patients, they found that statin use reduced the risk of in-hospital mortality within 1-month of hospital admission by approximately 50%.
People taking statins also had lower levels of compounds associated with inflammation, such as C-reactive protein.
The current study represents one of the largest Western studies of its kind to indicate a positive link between COVID-19 survival and statin use.
But researchers must confirm these findings with larger, randomized trials that reduce the risk of unexplained or unaccounted for influencing factors. For example, in the retrospective study, it was unclear how long people taking statins had been using them or how strictly they took them.
“If their beneficial effect bears out in randomized clinical trials, statins could potentially prove to be a low-cost and effective therapeutic strategy for COVID-19,” says the study’s co-lead author, Dr. Mahesh V. Madhavan, MD, a cardiologist at NewYork-Presbyterian/Columbia University Irving Medical Center.
Researchers will also have to figure out whether the effectiveness or usefulness of statins in treating COVID-19 varies between populations and countries.
Right now, several randomized studies are underway to find out whether statin use can reduce the risk of hospitalization for COVID-19 and the risk of death in hospitalized patients.
One of the study’s authors, Dr. Behnood Bikdeli, a fellow in vascular medicine at Brigham and Women’s Hospital in Boston, MA., is conducting a randomized trial exploring the impact of statin use in COVID-19 ICU patients in Iran.