ABSTRACT
Background: Coronavirus disease 2019 (COVID-19) remains a public health problem worldwide. There is conflicting evidence about the impact of statins use on clinical outcomes in patients with COVID-19. Purpose: We performed a systematic review and meta-analysis to assess the effect of statins use on mortality in these patients. Methods: We searched electronic databases from inception to March 3, 2021 for cohort studies evaluating the association between chronic and/or inpatient use of statins and mortality. Risk of bias was assessed using the Newcastle-Ottawa Scale. We pooled unadjusted and adjusted effect estimates with their 95% confidence intervals (95% CI) using random-effects models. Results: A total of 25 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 according to the 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 the use of statins was independently associated with a significant reduction of mortality. Adjusted confounders included age, sex, and cardiovascular comorbidities in most of cohorts. Eighteen studies were scored as low risk of bias, six studies as moderate risk of bias, and one study as high risk of bias. Conclusion: The use of statins was associated with lower mortality in patients with COVID-19 based on adjusted effects of cohort studies. However, randomized controlled trials are needed to confirm these findings.