Department of Internal Medicine, Division of Infectious Diseases, Kaohsiung Veterans General Hospital, Kaohsiung City, ROC.
Faculty of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, ROC.
Ann Med. 2021 Dec;53(1):874-884. doi: 10.1080/07853890.2021.1933165.
Statins are widely used to treat people with metabolic and cardiovascular disorders. The effect of statins on coronavirus disease 2019 (COVID-19) is unclear. To investigate the association between statins and COVID-19 outcomes and, if possible, identify the subgroup population that benefits most from statin use.
A systematic review and meta-analysis of published studies that included statin users and described COVID-19 outcomes through 10 November 2020. This study used the generic inverse variance method to perform meta-analyses with random-effects modelling. The main outcomes were evaluation of the need for invasive mechanical ventilator (IMV) support, the need for intensive care unit (ICU) care and death. All outcomes were measured as dichotomous variables.
A total of 28 observational studies, covering data from 63,537 individuals with COVID-19, were included. The use of statins was significantly associated with decreased mortality (odds ratio [OR] = 0.71, 95% confidence interval [CI]: 0.55-0.92, =72%) and the need for IMV (OR = 0.81, 95% CI: 0.69-0.95, =0%) but was not linked to the need for ICU care (OR = 0.91, 95% CI: 0.55-1.51, =66%). Subgroup analysis further identified five types of studies in which statin users had even lower odds of death.
The use of statins was significantly associated with a reduced need for IMV and decreased mortality among individuals with COVID-19. Statins may not need to be discontinued because of concern for COVID-19 on admission. Further randomized controlled trial (RCTs) are needed to clarify the causal effect between statin use and severe COVID-19 outcomes.Key messagesParticipants in five types of studies were shown to have even lower odds of death when taking statins.The use of statins was significantly associated with a reduced need for invasive mechanical ventilation and decreased all-cause mortality among individuals with COVID-19. However, statin use did not prevent participants from needing care in the intensive care unit.The results justify performing randomized controlled trials (RCTs) to validate the benefits of statins on COVID-19 outcomes.
他汀类药物被广泛用于治疗代谢和心血管疾病患者。他汀类药物对 2019 年冠状病毒病（COVID-19）的影响尚不清楚。本研究旨在探讨他汀类药物与 COVID-19 结局的相关性，并尽可能确定从他汀类药物治疗中获益最大的亚组人群。
系统检索并分析了截至 2020 年 11 月 10 日发表的评估他汀类药物使用者 COVID-19 结局的研究，采用随机效应模型的通用倒数方差法进行荟萃分析。主要结局为评估是否需要有创机械通气（invasive mechanical ventilator，IMV）支持、需要入住重症监护病房（intensive care unit，ICU）和死亡。所有结局均以二分类变量表示。
共纳入 28 项观察性研究，涵盖了 63537 例 COVID-19 患者的数据。他汀类药物的使用与死亡率降低（比值比 [odds ratio，OR] = 0.71，95%置信区间 [confidence interval，CI]：0.55-0.92，P=72%）和需要 IMV 支持（OR = 0.81，95%CI：0.69-0.95，P=0%）显著相关，但与需要入住 ICU（OR = 0.91，95%CI：0.55-1.51，P=66%）无关。亚组分析进一步确定了五类研究，其中他汀类药物使用者的死亡风险更低。
COVID-19 患者使用他汀类药物与需要 IMV 支持的可能性降低和死亡率降低显著相关。因担心 COVID-19 而入院时，他汀类药物可能无需停用。需要进一步开展随机对照试验（randomized controlled trial，RCT）以阐明他汀类药物使用与 COVID-19 严重结局之间的因果关系。
在五类研究中，他汀类药物使用者的死亡风险更低。
COVID-19 患者使用他汀类药物与降低需要有创机械通气和降低全因死亡率显著相关。然而，他汀类药物的使用并不能防止患者需要入住重症监护病房。
研究结果支持开展随机对照试验（RCT），以验证他汀类药物对 COVID-19 结局的益处。
