Statins and SARS-CoV-2 disease: Current concepts and possible benefits

Abstract

Background and aims

Inflammation-mediated tissue injury is the major mechanism involved in the pathogenesis of coronavirus disease 2019 (COVID-2019), caused by Severe Acute Respiratory Syndrome-Coronavirus-2 (SARS-CoV-2). Statins have well-established anti-inflammatory, anti-thrombotic and immuno-modulatory effects. They may also influence viral entry into human cells.

Methods

A literature search was done using PubMed and Google search engines to prepare a narrative review on this topic.

Results

Statins interact with several different signaling pathways to exert their anti-inflammatory and vasculoprotective effects. They also variably affect cholesterol content of cell membranes and interfere with certain coronavirus enzymes involved in receptor-binding. Both these actions may influence SARS-CoV-2 entry into human cells. Statins also upregulate expression of angiotensin-converting enzyme 2 (ACE2) receptors on cell surfaces which may promote viral entry into the cells but at the same time, may minimize tissue injury through production of angiotensin [1-7]. The net impact of these different effects on COVID-19 pathogenesis is not clear. However, the retrospective clinical studies have shown that statin use is potentially associated with lower risk of developing severe illness and mortality and a faster time to recovery in patients with COVID-19.

Conclusions

Early observations suggest beneficial effect of statin use on the clinical outcomes in COVID-19. Prospective randomized studies as well as well-designed laboratory studies are required to confirm these observations and to elucidate the mechanisms of such benefits, if proven.

Highlights

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  Statins have well-established anti-inflammatory, anti-thrombotic and immuno-modulatory effects.

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  They may also influence SARS-CoV-2 entry into human cells, but the net effect is unclear.

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  Retrospective studies have shown lower risk of severe illness and mortality with COVID-19 among statin users.

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  Randomized studies are required to confirm these initial observations.