Saakshi Bangera, DY Patil School of Biotechnology and Bioinformatics
Despite the improving research methodologies and treatments, COVID-19 continues to spread, causing deaths and morbidity across the world. It has been found that statins can potentially decrease the severity of COVID-19. However, this field has been less researched due to limited size and region-centred studies.
Statins are used by individuals with cardiovascular diseases and hypertension, as well as healthier people for preventing heart diseases. Numerous mechanisms have been proposed for the potential of statins to benefit in the case of COVID-19. The proposed mechanisms are listed below:
- Cardioprotective effect against myocardial damage via direct inhibition of the virus
- Anti-inflammatory effect of statins
- Preventing ROS (reactive oxygen species) damage by reducing oxidative stress
- Improving the function of endothelial cells
This study evaluates the relationship of statin therapy (in healthy individuals) on the severity of infection among the patients suffering from COVID-19.
Findings of the study
71% of patients were suffering from either CVD, hypertension or both. Out of these, 85% were consuming statin or anti-HTN (anti-hypertensive drug). Compared to subjects not taking any medications, patients taking statins or anti-HTN were more likely to be co-morbid.
Patients who died were more liable to have CVD and hypertension as compared to those who survived. Additionally, these patients were more likely to be on statins.
In this study, the use of statins before admission resulted in a greater than 40% reduction in mortality. It also led to a reduction in the risk of developing a severe outcome. The size of this risk reduction was larger for the use of anti-hypertensive medications solitarily.
Considering the risk of developing severe COVID-19, there is a complex relationship between the conditions (CVD and hypertension) and the medications used to treat them. Most patients were suffering from either CVD, hypertension or both. At least one relevant medication was taken by a majority of this population. Using propensity-score matches analysis, it was found that the property of risk reduction from statins or anti-HTN among patients with CVD or hypertension was less evident among healthier users of these drugs. A new finding is the association of statins in providing a large short-term benefit in the setting of COVID-19.
Beyond treating primary disease conditions, there are several possible mechanisms how statins could directly ease the outcomes in COVID-19. Death due to cardiovascular damage in COVID-19 is a result of the inflammatory cascade. Statin therapy decreases inflammation and provides plaque stabilization effects, independent of elevated cholesterol levels. Statin therapy is also associated with better survival in patients with community-acquired pneumonia. Presumably, statins also have a direct inhibitory effect against SARS-CoV2 and may exhaust cholesterol from cell membranes eventually resulting in coronavirus suppression.
Due to the large study populations, the study addresses the significant relationships between statin and anti-HTN use, and CVD and hypertension.
Significance of the study
During the early pandemic, it was hypothesized that medications such as statins and ACE inhibitors increased the susceptibility of people to COVID-19. This study proves that it is clinically safe to remain on these medications. It was also proved that these medications may significantly reduce the risk of severe COVID-19 and death.
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Source: Daniels, L. B., Ren, J., Kumar, K., Bui, Q. M., Zhang, J., Zhang, X., Sawan, M. A., Eisen, H., Longhurst, C. A., & Messer, K. (2021). Relation of prior statin and anti-hypertensive use to severity of disease among patients hospitalized with COVID-19: Findings from the American Heart Association’s COVID-19 Cardiovascular Disease Registry. PLOS ONE, 16(7), e0254635. https://doi.org/10.1371/journal.pone.0254635
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