Cholesterol-lowering drugs called statins have proven controversial in the past, but they may cut your risk of dying from Covid-19, a new study suggests.
Researchers in San Diego analysed anonymised medical records from a national American registry during the pandemic.
The sample consisted of people who either had or hadn’t taken statins prior to contracting Covid-19 and being admitted to hospital.
Researchers found that the drug – which is taken as a pill and can be bought over the counter in some areas – slashes the risk of dying in hospital from Covid-19 by 41 per cent.
Statins are a class of drugs that lower levels of ‘bad’ low-density lipoprotein (LDL) cholesterol, which can lead to lead to a hardening and narrowing of the arteries and therefore heart attacks and strokes.
Cutting LDL cholesterol by taking statins may have anti-inflammatory effects, because LDL itself strongly promotes inflammation, thereby possibly making patients more likely to survive the inflammatory symptoms of Covid.
Statins are a group of medicines that can help lower the level of low-density lipoprotein (LDL) cholesterol in the blood
The study has been led by Lori Daniels, professor and director of the Cardiovascular Intensive Care Unit at UC San Diego Health.
Covid-fighting properties of statins could also be related to angiotensin-converting enzyme 2 (ACE2), the researchers claim.
ACE2 – an enzyme attached to the cell membranes of cells located in the arteries and lungs – is already known to be the ‘gateway’ for coronavirus infection.
SARS-CoV-2 has a spike on the surface of its envelope called an S-protein which allows it to bind with the ACE2 receptor located on human cells.
Once the spike has opened the door for the virus to enter the cell, the genetic material of SARS-CoV-2, its RNA, binds to myriad proteins and begins replicating.
‘When faced with this virus at the beginning of the pandemic, there was a lot of speculation surrounding certain medications that affect the body’s ACE2 receptor, including statins, and whether they may influence Covid-19 risk,’ said Professor Daniels.
‘At the time, we thought that statins may inhibit SARS-CoV-2 infection through their known anti-inflammatory effects and binding capabilities, which could potentially stop progression of the virus.’
Illustration of SARS-CoV-2 virus binding to ACE2 receptors on a human cell, the initial stage of Covid infection
For their study, the experts used data from the American Heart Association’s Covid-19 Cardiovascular Disease Registry.
This database contains de-identified health data on patients treated for Covid at more than 140 participating hospitals across the country.
As of July 2021, data from more than 49,000 patient records had been contributed into the platform.
The research team analysed anonymised medical records of 10,541 patients in the registry who were admitted for Covid over a nine-month period, January through September 2020, at 104 different US hospitals.
‘From this data, we performed more advanced analyses as we attempted to control for coexisting medical conditions, socioeconomic status and hospital factors,’ said Professor Daniels.
‘In doing so, we confirmed our prior findings that statins are associated with a reduced risk of death from Covid-19 among patients hospitalised for Covid-19.’
Those who benefitted the most seemed to have good medical reasons to be taking statins, such as a history of cardiovascular disease or high blood pressure.
According to the research team, the use of statins or an anti-hypertension medication was associated with a 32 per cent lower risk of death among Covid inpatients with a history of cardiovascular disease or hypertension.
This can also be attributed to the ACE2 receptor, which helps control blood pressure.
Patients with any statin use (alone or in combination with anti-hypertension medication) had a 41 per cent lower odds of death.
Compared to those taking neither class of medication, patients taking a statin alone had a 46 per cent lower odds of death, while those on both statin and anti-hypertension medication had a 40 per cent lower odds.
Statistical matching techniques were used to compare outcomes for patients who used statins or anti-hypertension medication with similar patients who did not.
‘We matched each patient to one or more similar patients, using hospital site, month of admission, age, race, ethnicity, gender, and a list of pre-existing conditions, in order to make the two groups as comparable as possible’ said co-author Professor Karen Messer.
But the study did not confirm that statins were definitely the cause of survival.
‘As with any observational study, we cannot say for certain that the associations we describe between statin use and reduced severity of Covid-19 infection are definitely due to the statins themselves,’ said Professor Daniels.
‘However, we can now say with very strong evidence that they may play a role in substantially lowering a patient’s risk of death from Covid-19.
‘We hope that our research findings are an incentive for patients to continue with their medication.’
This new study builds on research published by UC San Diego Health last year that only included 170 anonymised medical records from patients specifically receiving care at UC San Diego Health.
Hypertension – high blood pressure – is one of the main risk factors of cardiovascular diseases
At the time, researchers found that statin use prior to hospital admission for Covid resulted in a more than 50 per cent reduction in risk of developing severe infection.
Statins are widely prescribed – the Centers for Disease Control estimates that 93 per cent of patients who use a cholesterol-lowering drug use them.
While statins are generally well tolerated, many people report aches and pains as a side effect, which may lead some to stop taking the drug.
They cause some minor side effects, such as diarrhoea, headaches and nausea, according to the NHS, but they can prevent serious health problems.
The new study, which has been published in the journal PLOS One, follows plenty of research into their various benefits.
Last year, experts at VA Boston Health Care System, a branch of hospitals in Massachusetts, found deaths from any cause were 25 per cent lower for those who took statins, from a sample of 300,000 veterans aged 75 years or more.
In 2019, another study found that up to 8,000 deaths could be avoided saved annually in the UK if everyone over the age of 75 received statins.
Men who are on statins have a 24 per cent lower risk of a deadly form of prostate cancer, a study in 2019 also revealed.
And in 2017, a 20-year review by British researchers found the pills slashed the risk of an early death by 28 per cent.
Despite this, there has long been controversy over whether statins should be taken routinely by elderly people.
‘This topic has been controversial with several mixed results in the past, showing either no benefit or little benefit of statins in this age group,’ said Dr Riyaz Patel, associate professor of cardiology at University College London.
‘This in turn has led to uncertainty whether statins should be started or even stopped in older people.’