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      Statins reduce mortality in patients with COVID-19: an updated meta-analysis of 147,824 patients

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          Abstract

          Objectives

          There is conflicting evidence about the utility of statins use on clinical outcomes in patients with coronavirus disease 2019 (COVID-19). We performed a systematic review and meta-analysis to examine the effect of statins use on mortality in COVID-19 patients.

          Methods

          We searched electronic databases from inception to March 3, 2021. We pooled unadjusted and adjusted effect estimates with their 95% confidence intervals (95% CI) using random-effects models.

          Results

          Twenty-five cohort studies involving 147824 patients were included. The mean age ranged from 44.9 to 70.9 years and 57% of patients were men. The use of statins was not associated with mortality using unadjusted risk ratio (uRR, 1.16; 95% CI, 0.86-1.57, 19 studies). In contrast, meta-analyses of adjusted odds ratio (aOR, 0.67; 95% CI, 0.52-0.86, 11 studies) and adjusted hazard ratio (aHR, 0.73; 95% CI, 0.58-0.91, 10 studies) showed that statins were independently associated with a significant reduction of mortality. Subgroup analyses showed that only chronic use of statins significantly reduced mortality according to the adjusted models.

          Conclusions

          The use of statins was associated with a lower risk of mortality in COVID-19 patients based on adjusted effects of cohort studies. However, randomized controlled trials are still needed to confirm these findings.

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          Most cited references37

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          Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement

          David Moher and colleagues introduce PRISMA, an update of the QUOROM guidelines for reporting systematic reviews and meta-analyses
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            • Article: not found

            Risk Factors Associated With Mortality Among Patients With COVID-19 in Intensive Care Units in Lombardy, Italy

            Many patients with coronavirus disease 2019 (COVID-19) are critically ill and require care in the intensive care unit (ICU).
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              Pleiotropic Effects of Statins on the Cardiovascular System.

              The statins have been used for 30 years to prevent coronary artery disease and stroke. Their primary mechanism of action is the lowering of serum cholesterol through inhibiting hepatic cholesterol biosynthesis thereby upregulating the hepatic low-density lipoprotein (LDL) receptors and increasing the clearance of LDL-cholesterol. Statins may exert cardiovascular protective effects that are independent of LDL-cholesterol lowering called pleiotropic effects. Because statins inhibit the production of isoprenoid intermediates in the cholesterol biosynthetic pathway, the post-translational prenylation of small GTP-binding proteins such as Rho and Rac, and their downstream effectors such as Rho kinase and nicotinamide adenine dinucleotide phosphate oxidases are also inhibited. In cell culture and animal studies, these effects alter the expression of endothelial nitric oxide synthase, the stability of atherosclerotic plaques, the production of proinflammatory cytokines and reactive oxygen species, the reactivity of platelets, and the development of cardiac hypertrophy and fibrosis. The relative contributions of statin pleiotropy to clinical outcomes, however, remain a matter of debate and are hard to quantify because the degree of isoprenoid inhibition by statins correlates to some extent with the amount of LDL-cholesterol reduction. This review examines some of the currently proposed molecular mechanisms for statin pleiotropy and discusses whether they could have any clinical relevance in cardiovascular disease.

                Author and article information

                Journal
                Int J Infect Dis
                Int J Infect Dis
                International Journal of Infectious Diseases
                Published by Elsevier Ltd on behalf of International Society for Infectious Diseases.
                1201-9712
                1878-3511
                8 August 2021
                8 August 2021
                Affiliations
                [1 ]Vicerrectorado de Investigación, Universidad San Ignacio de Loyola, Lima, Peru
                [2 ]Programa de Atencion Domiciliaria – EsSalud, Lima, Peru
                [3 ]Asociación para el Desarrollo de la Investigación Estudiantil en Ciencias de la Salud (ADIECS), Lima, Peru
                [4 ]International Research Network in Pharmacology and Precision Medicine, Human Medicine, Universidad San Ignacio de Loyola, Lima, Peru
                [5 ]Servicio de Pediatria, Hospital III Suarez-Angamos – EsSalud, Lima, Peru
                [6 ]Health Outcomes, Policy and Evidence Synthesis (HOPES) Group, University of Connecticut School of Pharmacy, Storrs, CT, USA
                Author notes
                [* ] Corresponding author: Carlos Diaz-Arocutipa, MD, Vicerrectorado de Investigación, Universidad San Ignacio de Loyola, Av. La Fontana 550, La Molina, Lima 00012, Peru
                Article
                S1201-9712(21)00636-6
                10.1016/j.ijid.2021.08.004
                8349445
                34375760
                597ebda0-19c0-4d5d-970e-3867aee4d11b
                © 2021 Published by Elsevier Ltd on behalf of International Society for Infectious Diseases.

                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
                : 27 May 2021
                : 22 July 2021
                : 4 August 2021
                Categories
                Article

                Infectious disease & Microbiology
                statins,mortality,covid-19,systematic review
                Infectious disease & Microbiology
                statins, mortality, covid-19, systematic review

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