Cholesterol-Lowering Statins: Do They Help With COVID-19?

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  • In a new study, researchers examined the medical records of over 38,000 patients hospitalized for COVID-19.
  • Statin users were 37% less likely to die from COVID-19 compared to people who didn’t use statins.
  • The study was conducted before COVID-19 vaccines were authorized by the FDA.

Common medications used to lower cholesterol may reduce the severity of COVID-19 and the risk of dying from this disease, a preliminary study suggests.

Some previous research has shown similar COVID-related benefits of statins. However, other studies have found that these drugs had little impact on COVID-19 severity or mortality.

Additional research, including well-designed randomized controlled trials, are needed to know whether statins will work as a COVID-19 treatment.

However, experts say statins can reduce the risk of complications of cardiovascular disease — regardless of whether someone has or had COVID-19.

Statin users had  better COVID-19 outcomes

In the new study, researchers examined the electronic medical records of over 38,000 patients hospitalized for COVID-19 in the United States between January and September 2020.

This was before the COVID-19 vaccines were authorized in the country by the Food and Drug Administration.

Of the patients included in the study, 30% regularly used statins as a treatment for high cholesterol.

The US Preventive Services Task Force recommends statins for adults aged 40 to 75 years with certain risk factors for cardiovascular disease. Between 2017 to 2020, an estimated 45% of eligible Americans 40 years and older used a statin.

By examining patients’ medical records, the authors of the new study found that statin users were 37% less likely to die from COVID-19 compared to people who didn’t use statins.

In addition, regular statin users were less likely to be discharged to hospice, be admitted to the intensive care unit or develop blood clots. They also spent less time in the hospital and less time on a ventilator helping them breathe.

“Our results suggest statins could be an additional cost-effective solution against COVID-19 disease severity and should be studied further,” study author Dr. Ettore Crimi, professor of anesthesiology and critical care medicine at the University of Central Florida in Orlando, said in a news release.

The study was presented Oct. 22 at the 2022 American Society of Anesthesiologists Annual Meeting. It has not yet been peer-reviewed.

Several mechanisms have been proposed for how statins might reduce COVID-19 severity and risk of death.

Statins have anti-inflammatory effects on the body. This may be helpful during COVID-19, which can cause severe inflammation that damages organs and the lining of the blood vessels.

These drugs may also block the coronavirus that causes COVID-19 from infecting cells in the body.

However, statins likely benefit COVID-19 patients the same way they benefit people without COVID-19.

“Mostly, I think [statins] work by stabilizing atherosclerotic plaques that are more likely to cause heart attacks or strokes, reducing the risk of those complications,” said Dr. Matthew S. Durstenfeld, a cardiologist and assistant professor of medicine at the University of California, San Francisco.

Observational studies have mixed results

Other observational studies — some larger than the new study — have shown similar, but sometimes mixed, results.

In a study of over 230,000 US veterans who tested positive for COVID-19 between March 2020 and March 2021, statin users were nearly 20% less likely to die from any cause within 30 days, compared to non-statin users.

However, the benefits of statins were much stronger when researchers looked at veterans without a positive COVID-19 test — those taking statins were 40% less likely to die within 30 days versus those not taking statins.

This suggests that the effect of statins on the risk of dying are not “specific” to people with COVID-19, wrote the researchers.

Another study of over 10,500 patients hospitalized with COVID-19 from the beginning of the pandemic through September 2020 found that those taking statins were over 40% less likely to die — from any cause — in the hospital.

However, the benefits of statins in this study were stronger in people with underlying cardiovascular disease. This is not surprising.

“We know statins reduce the risk of heart attack and stroke in people with cardiovascular risk, and COVID-19 increases the risk of these events,” said Durstenfeld. “So individuals with cardiovascular disease are more likely to benefit from statin therapy around the time of COVID-19.”

Additional randomized trials needed

Most of the observational studies looking at the benefits of statins for people with COVID-19 were retrospective, meaning researchers reviewed patients’ medical records after their visits had occurred.

This kind of research can help identify potential treatments that might work, but these studies have certain limitations.

“While such a study design can be useful in identifying key information quickly, it is not uncommon to find variation in the results based on the background characteristics of the patients studied, regions and severity of illness,” said Dr. John D. Bisognano, director of general, consultative and preventive cardiology at the University of Michigan Frankel Cardiovascular Center in Ann Arbor.

A stronger type of study design is the randomized controlled trial (RCT), in which patients are randomly assigned to different groups — such as receiving statins or an inactive placebo.

However, “[RCTs] take more time and effort than retrospective trials and, when dealing with a new disease like COVID-19, time is important,” said Bisognano, who is also a professor of internal medicine at the University of Michigan Medical School.

Some RCTs of statins as a treatment for COVID-19 have already been completed, without promising results.

In one study, COVID-19 patients admitted to the ICU received either a statin or an inactive placebo. In a second study, hospitalized COVID-19 patients received a statin, aspirin or both.

In both studies, patients who received statins had similar COVID-19 outcomes as patients who didn’t receive statins.

“One explanation for the lack of a statistically significant benefit in these two randomized trials,” said Durstenfeld, “is that they included individuals at lower cardiovascular risk who are less likely to benefit from statins.”

Again, this suggests that the COVID-related benefits of statins are stronger for people with underlying cardiovascular disease.

General benefits of statins

Other RCTs are ongoing, but have yet to report results.

Until these trials are finished, Durstenfeld said the “jury is still out” on whether statins can lower the risk of severe COVID-19. Also unknown, he said, is whether statin therapy can lower the risk of long COVID or can be used to treat it.

So, “while we await [results from] the remainder of the statin trials, my perspective is that those individuals with a reason to be on a statin — apart from COVID-19 — should probably continue or initiate statin therapy,” he said.

“But I would not start [statin therapy] specifically to try to improve COVID-19 outcomes outside of the context of a clinical trial,” he added.

In spite of the need for additional research on statins, there are already proven ways to reduce the risk of severe COVID-19 and dying of COVID-19.

“For people wanting to minimize their risk of bad outcomes in COVID-19, the best strategy is vaccination, including booster shots when recommended, and medications like Paxlovid for high-risk people,” said Dr. Ann Marie Navar, a cardiologist and associate professor from UT Southwestern Medical Center in Dallas.

In addition, many studies have shown that statins definitely benefit people with cardiovascular disease.

“We have decades of clinical trial data that say that in people with heart disease or at high risk for heart disease, statins prevent heart attack and stroke and lower the risk of death,” said Navar.

“As a cardiologist, whether or not [statins] have an independent benefit in COVID-19 is somewhat irrelevant,” she added. “I use statins to prevent cardiovascular complications.”

Managing existing cardiovascular disease may also help people fight other diseases or conditions, such as seasonal flu, pneumonia, cancer or traumatic injuries, said Bisognano.

“Cardiovascular disease of any sort can make fighting just about any other medical condition more challenging,” he said. “It doesn’t just apply to COVID-19.”

He recommends that people with cardiovascular disease or risk factors such as high blood pressure, high cholesterol and obesity take steps to reduce their risks — including maintaining a healthy weight, and taking statins or blood pressure medications if recommended by their doctor.

“Keeping oneself in good health improves one’s odds of fighting any disease or condition,” he said.

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