Common medication used to reduce cholesterol levels may reduce COVID-19 severity

by University of California - San Diego

Credit: Pixabay/CC0 Public Domain

In a new study from University of California San Diego School of Medicine, researchers have confirmed that patients taking statin medications had a 41 percent lower risk of in-hospital death from COVID-19. The findings were published July 15, 2021 in PLOS ONE and expand upon prior research conducted at UC San Diego Health in 2020.

18 july 2021--Statins are commonly used to reduce blood cholesterol levels by blocking liver enzymes responsible for making cholesterol. They are widely prescribed: The Centers for Disease Control estimates that 93 percent of patients who use a cholesterol-lowering drug use a statin.

"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 Lori Daniels, MD, lead study author, professor and director of the Cardiovascular Intensive Care Unit at UC San Diego Health.

"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."

Using data from the American Heart Association's COVID-19 Cardiovascular Disease Registry, the research team at UC San Diego applied their original findings to a much larger cohort: more than 10,000 hospitalized COVID-19 patients across the United States.

Specifically, researchers analyzed anonymized medical records of 10,541 patients admitted for COVID-19 over a nine-month period, January through September 2020, at 104 different hospitals.

"From this data, we performed more advanced analyses as we attempted to control for coexisting medical conditions, socioeconomic status and hospital factors," said Daniels. "In doing so, we confirmed our prior findings that statins are associated with a reduced risk of death from COVID-19 among patients hospitalized for COVID-19."

Daniels said it appears most of the benefit is among patients with 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 percent lower risk of death among COVID-19 inpatients with a history of cardiovascular disease or hypertension.

In the study, statistical matching techniques were used to compare outcomes for patients who used statins or an 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 Karen Messer, Ph.D., study co-author and professor of biostatistics at UC San Diego School of Medicine.

The ACE2 receptor—the regulatory target of statins—helps control blood pressure. In 2020, it was discovered that SARS-CoV-2 virus primarily uses the same receptor to enter lung cells.

According to researchers, statins and anti-hypertension medications stabilize the underlying diseases for which they are prescribed, making patients more likely to recover from COVID-19.

"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; 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," said Daniels. "We hope that our research findings are an incentive for patients to continue with their medication."

The initial study included 170 anonymized medical records from patients receiving care at UC San Diego Health. Researchers found that statin use prior to hospital admission for COVID-19 resulted in a more than 50 percent reduction in risk of developing severe infection.

The American Heart Association's COVID-19 Cardiovascular Disease Registry contains de-identified health data on patients treated for COVID-19 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.

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More information: Lori B. Daniels et al, 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, PLOS ONE (2021). DOI: 10.1371/journal.pone.0254635

Provided by University of California - San Diego 

Study: Cholesterol drug lowers blood clot risk

By MARILYNN MARCHIONE

ORLANDO, Fla., 31 mar 2009 – Statin drugs, taken by millions of Americans to lower cholesterol and prevent heart disease, also can cut the risk of developing dangerous blood clots that can lodge in the legs or lungs, a major study suggests.

The results provide a new reason for many people with normal cholesterol to consider taking these medicines, sold as Crestor, Lipitor, Zocor and in generic form, doctors say.

In the study, Crestor cut nearly in half the risk of blood clots in people with low cholesterol but high scores on a test for inflammation, which plays a role in many diseases. This same big study last fall showed that Crestor dramatically lowered rates of heart attacks, death and stroke in these people, who are not usually given statins now.

"It might make some people who are on the fence decide to go on statins," although blood-clot prevention is not the drugs' main purpose, said Dr. Mark Hlatky, a Stanford University cardiologist who had no role in the study.

Results were reported Sunday at the American College of Cardiology conference and published online by the New England Journal of Medicine.

The study was led by statistician Robert Glynn and Dr. Paul Ridker of Harvard-affiliated Brigham and Women's Hospital in Boston. Ridker is a co-inventor on a patent of the test for high-sensitivity C-reactive protein, or CRP. It is a measure of inflammation, which can mean clogged arteries or less serious problems, such as an infection or injury.

It costs about $80 to have the blood test done. The government does not recommend it be given routinely, but federal officials are reconsidering that.

For the study, researchers in the U.S. and two dozen other countries randomly assigned 17,802 people with high CRP and low levels of LDL, or bad cholesterol (below 130), to take dummy pills or Crestor, a statin made by British-based AstraZeneca PLC.

With an average of two years of follow-up, 34 of those on Crestor and 60 of the others developed venous thromboembolism — a blood clot in the leg that can travel to the lungs. Several hundred thousand Americans develop such clots each year, leading to about 100,000 deaths.

However, this is uncommon compared to the larger number who suffer heart attacks. Many doctors have been uncomfortable with expanding statin use to people with normal cholesterol because so many would have to be treated to prevent a single additional case.

"I don't know that it changes the big picture very much" to say that a statin can prevent blood clots, Hlatky said. "Where do you draw the line? Are we giving it to 10-year-old kids that are fat?"

AstraZeneca paid for the study, and Ridker and other authors have consulted for the company and other statin makers. Many doctors believe that other statins would give similar benefits, though Crestor is the strongest such drug. It also has the highest rate of a rare but serious muscle problem, and the consumer group Public Citizen has campaigned against it, saying there are safer alternatives.

Crestor costs $3.45 a day versus less than a dollar for generic drugs. Its sales have been rising even though two statins — Zocor and Pravachol — are now available in generic form.

Researchers do not know whether the benefits seen in the study were due to reducing CRP or cholesterol, since Crestor did both. Another new analysis reported Sunday and published in the British journal the Lancet found that the patients who did the best in the study were those who saw both numbers drop.

Many doctors remain reluctant to expand CRP testing or use of statins. A survey by the New England journal found them evenly divided on the questions. Others questioned why so few people in the study were getting other treatments to prevent heart problems.

"If more of them were on aspirin, you would have less benefit from the statin," said Dr. Thomas Pearson of the University of Rochester School of Medicine and Dentistry.

Dr. James Stein of the University of Wisconsin-Madison said that doctors examining treatment guidelines should pay close attention to the new results.

He said the CRP test had helped him convince patients that they need to be on a statin drug.

"There are very few times you can say to a patient, 'this medicine is going to keep you alive.' We should try not to pick apart studies that save lives," Stein said.