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

• Authors: Lori B Daniels, University of California San Diego; Junting Ren, University of California San Diego; Kris Kumar, Oregon Health and Science University; Quan M Bui, University of California San Diego; Jing Zhang, University of California San Diego; Xinlian Zhang, University of California San Diego; Mariam A Sawan, Emory University; Howard Eisen, Pennsylvania State Health; Christopher A Longhurst, University of California San Diego; Karen Messer, University of California San Diego
• Journal Title: PLOS ONE
• Volume: Volume 16, Number 7
• Publisher: PUBLIC LIBRARY SCIENCE | 2021-07-15, Pages e0254635-e0254635
• Type of Work: Article | Final Publisher PDF
• Publisher DOI: http://doi.org/10.1371/journal.pone.0254635
• Subjects: Health Sciences, Epidemiology; Biology, Biostatistics
• Keywords: Science & Technology; Multidisciplinary Sciences; Science & Technology - Other Topics; INFLUENZA; MORTALITY; THERAPY

Abstract

Background: Statins have anti-inflammatory and immunomodulatory effects that may reduce the severity of coronavirus disease 2019 (COVID-19), in which organ dysfunction is mediated by severe inflammation. Large studies with diverse populations evaluating statin use and outcomes in COVID-19 are lacking. Methods and results: We used data from 10,541 patients hospitalized with COVID-19 through September 2020 at 104 US hospitals enrolled in the American Heart Association's COVID-19 Cardiovascular Disease (CVD) Registry to evaluate the associations between statin use and outcomes. Prior to admission, 42% of subjects (n = 4,449) used statins (7% on statins alone, 35% on statins plus anti-hypertensives). Death (or discharge to hospice) occurred in 2,212 subjects (21%). Outpatient use of statins, either alone or with anti-hypertensives, was associated with a reduced risk of death (adjusted odds ratio [aOR] 0.59, 95% CI 0.50-0.69), adjusting for demographic characteristics, insurance status, hospital site, and concurrent medications by logistic regression. In propensity-matched analyses, use of statins and/or anti-hypertensives was associated with a reduced risk of death among those with a history of CVD and/or hypertension (aOR 0.68, 95% CI 0.58-0.81). An observed 16% reduction in odds of death among those without CVD and/or hypertension was not statistically significant. Conclusions: Patients taking statins prior to hospitalization for COVID-19 had substantially lower odds of death, primarily among individuals with a history of CVD and/or hypertension. These observations support the continuation and aggressive initiation of statin and anti-hypertensive therapies among patients at risk for COVID-19, if these treatments are indicated based upon underlying medical conditions.