Pros and cons for use of statins in people with coronavirus disease-19 (COVID-19)

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Abstract

Background and aims

Morbidity and mortality from coronavirus disease 2019 (COVID-19) is higher among people with diabetes mellitus (DM), hypertension, and cardiovascular disease (CVD). Statins are used in the majority of people with DM and CVD. This mini-review discusses the current understanding of benefit-risk ratio of use of statins in COVID-19.

Methods

We searched PubMed database using specific keywords related to our aims till June 12, 2020. Full text of relevant articles published in English language were retrieved and reviewed.

Results

Statins, with their immunomodulatory, anti-inflammatory, anti-thrombotic, and anti-oxidant properties, have the potential to reduce severity of lung injury in, and mortality from, severe acute respiratory syndrome-coronavirus 2 (SARS-CoV2) infections. Statin-induced upregulation of angiotensin-converting enzyme-2 (ACE2) has the potential to reduce lung injury from excess angiotensin II. By disrupting lipid rafts, statins have the potential to reduce viral entry into cells. However, benefit-risk ratio of its complex interaction with MYD88 gene expression on outcomes in COVID-19, and the putative role of low serum LDL cholesterol in increasing severity of SARS-CoV2 infection need further clarification.

Conclusions

People with COVID-19, who are already on statins for an underlying co-morbid condition, should continue on it unless there are specific contraindications. De-novo use of statins in people with COVID-19 with no underlying co-morbidity might be beneficial but awaits substantiation in clinical trials; till that time, de novo use of statins in COVID 19 should be limited to a clinical trial setting.

Highlights

•

Statins have many pleiotropic properties that can potentially reduce morbidity and mortality in coronavirus disease-19.
•

People with coronavirus disease-19 who are already on a statin should continue on it unless there is a contraindication.
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Pending further evidence, de-novo use of statins in coronavirus disease-19 should be limited to a clinical trial setting.

Related collections

Most cited references 28

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Characteristics of and Important Lessons From the Coronavirus Disease 2019 (COVID-19) Outbreak in China: Summary of a Report of 72 314 Cases From the Chinese Center for Disease Control and Prevention

Zunyou Wu, Jennifer M. McGoogan (2020)

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Neurologic Manifestations of Hospitalized Patients With Coronavirus Disease 2019 in Wuhan, China

Ling Mao, Huijuan Jin, Mengdie Wang … (2020)

The outbreak of coronavirus disease 2019 (COVID-19) in Wuhan, China, is serious and has the potential to become an epidemic worldwide. Several studies have described typical clinical manifestations including fever, cough, diarrhea, and fatigue. However, to our knowledge, it has not been reported that patients with COVID-19 had any neurologic manifestations.

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Incidence of thrombotic complications in critically ill ICU patients with COVID-19

F.A. Klok, M.J.H.A. Kruip, N.J.M. van der Meer … (2020)

Introduction COVID-19 may predispose to both venous and arterial thromboembolism due to excessive inflammation, hypoxia, immobilisation and diffuse intravascular coagulation. Reports on the incidence of thrombotic complications are however not available. Methods We evaluated the incidence of the composite outcome of symptomatic acute pulmonary embolism (PE), deep-vein thrombosis, ischemic stroke, myocardial infarction or systemic arterial embolism in all COVID-19 patients admitted to the ICU of 2 Dutch university hospitals and 1 Dutch teaching hospital. Results We studied 184 ICU patients with proven COVID-19 pneumonia of whom 23 died (13%), 22 were discharged alive (12%) and 139 (76%) were still on the ICU on April 5th 2020. All patients received at least standard doses thromboprophylaxis. The cumulative incidence of the composite outcome was 31% (95%CI 20-41), of which CTPA and/or ultrasonography confirmed VTE in 27% (95%CI 17-37%) and arterial thrombotic events in 3.7% (95%CI 0-8.2%). PE was the most frequent thrombotic complication (n = 25, 81%). Age (adjusted hazard ratio (aHR) 1.05/per year, 95%CI 1.004-1.01) and coagulopathy, defined as spontaneous prolongation of the prothrombin time > 3 s or activated partial thromboplastin time > 5 s (aHR 4.1, 95%CI 1.9-9.1), were independent predictors of thrombotic complications. Conclusion The 31% incidence of thrombotic complications in ICU patients with COVID-19 infections is remarkably high. Our findings reinforce the recommendation to strictly apply pharmacological thrombosis prophylaxis in all COVID-19 patients admitted to the ICU, and are strongly suggestive of increasing the prophylaxis towards high-prophylactic doses, even in the absence of randomized evidence.

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Author and article information

Contributors

Gangopadhyay Kalyan K

Journal

Journal ID (nlm-ta): Diabetes Metab Syndr

Journal ID (iso-abbrev): Diabetes Metab Syndr

Title: Diabetes & Metabolic Syndrome

Publisher: Published by Elsevier Ltd on behalf of Diabetes India.

ISSN (Print): 1871-4021

ISSN (Electronic): 1878-0334

Publication date PMC-release: 11 July 2020

Publication date (Electronic): 11 July 2020

Affiliations

[a ]Department of Endocrinology and Diabetes, Apollo Gleneagles Hospitals, Kolkata, India

[b ]Department of Endocrinology and Diabetes, Fortis Hospital, Kolkata, India

Author notes

[∗ ]Corresponding author. Diabetes & Endocrinology, Fortis Hospitals, 730, Eastern Metropolitan Bypass. Kolkata, 700107, India. jaykal69@ 123456hotmail.com

Article

Publisher ID: S1871-4021(20)30259-9

DOI: 10.1016/j.dsx.2020.07.011

PMC ID: 7352102

PubMed ID: 32683320

SO-VID: 0527955f-a68e-49ef-a95c-b9141a0f1c49

License:

Since January 2020 Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on the novel coronavirus COVID-19. The COVID-19 resource centre is hosted on Elsevier Connect, the company's public news and information website. Elsevier hereby grants permission to make all its COVID-19-related research that is available on the COVID-19 resource centre - including this research content - immediately available in PubMed Central and other publicly funded repositories, such as the WHO COVID database with rights for unrestricted research re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for free by Elsevier for as long as the COVID-19 resource centre remains active.

History

Date received : 21 June 2020

Date revision received : 4 July 2020

Date accepted : 8 July 2020

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