Statin Use Is Associated with More Severe COVID-19 Disease in Hospitalized Patients

Background: Given the relatively modest benefit of currently available treatments in improving COVID-19 clinical outcomes, there is an urgent need for novel therapeutic strategies, especially in reversing associated lung inflammation. Attention has focused on repurposing existing agents with immune modulatory properties to accelerate their incorporation into clinical practice. Recent evidence has demonstrated that the cholesterol-lowering agents, statins, are associated with reduced mortality in patients with influenza, sepsis, community-acquired pneumonia, and chronic obstructive pulmonary diseases (COPD). We sought to investigate the relationship between statin use and COVID-19 disease severity in hospitalized patients. Methods: A retrospective analysis of COVID-19 patients admitted to the Johns Hopkins Medical Institutions between March 1, 2020 and June 30, 2020 was performed. The outcomes of interest were mortality and severe COVID-19 infection, as defined by prolonged hospital stay (≥ 7 days) and/ or invasive mechanical ventilation. Logistic regression, Cox proportional hazards regression and propensity score matching were used to obtain both univariable and multivariable associations between covariates and outcomes in addition to the average treatment effect of statin use. Results: Of the 4,447 patients who met our inclusion criteria, 594 (13.4%) patients were exposed to statins on admission, of which 340 (57.2%) were male. The mean age was higher in statin users compared to non-users [64.9 ± 13.4 vs. 45.5 ± 16.6 years, p <0.001]. The average treatment effect of statin use on COVID-19-related mortality was RR=1.00 (95% CI: 0.99 – 1.01, p= 0.928), while its effect on severe COVID-19 infection was RR=1.18 (95% CI: 1.11 – 1.27, p <0.001). Conclusion: Statin use was not associated with altered mortality, but with an 18% increased risk of severe COVID-19 infection. Funding Statement: The retrospective cohort study was supported by the National Institute of Allergy and Infectious Diseases (NIAID)/ National Institutes of Health (NIH) grants UH3AI122309 and K24AI143447 to P.C.K Declaration of Interests: We declare no competing interests. The Johns Hopkins Core for Clinical Research Data Acquisition provided the data for this analysis. Ethics Approval Statement: All procedures were in accordance with the ethical standards of the Johns Hopkins Medical Institutions and the Johns Hopkins COVID-19 and Data Research Evaluation (CADRE) Committee. The Johns Hopkins University School of Medicine IRB reviewed the study protocol and determined that it qualifies as exempt research under the DHHS regulations.