ABSTRACT
Objective: Statins result in lower H5N1 (influenza A) titers on viral exposure and inhibit Ebola virus production and glycoprotein processing. So a similar pattern might be a target for SARS-CoV-2. However, there are data that indicate statins upregulate ACE2 which may have an opposite effect on SARS-CoV-2 infection. To address this question we conducted a systematic review on the efficacy of statins on the risk of respiratory tract infections (RTIs). Design and method: Publications of head-to-head randomized controlled trials (RCTs) of statins were retrieved from MEDLINE, EMBASE, Web of Science, and Cochrane (from 2000-July 2021). We included RCTs with at least 100 participants and with a minimum follow-up of one year. Two authors independently selected the included trials, evaluated the risk of bias, and retrieved the data on RTIs. Meta-analyses were performed to summarise the pooled risk ratios (RRs) of RTIs between treatment arms. Results: The initial literature search identified 568 records. After duplicates were excluded, there were 318 records. Twenty-five RCTs were excluded after a fulltext review of the 29 eligible studies. In the end, four RCTs with a total of 7,912 participants were included in our meta-analysis. As to the effect of statins on RTIs, the point estimate for statins was less than 1, but it did not reach statistical significance in the overall analysis (the pooled RR in the fixed effect model was 0.99 [95% CI: 0.94, 1.04;I2 = 59%;x2 p = 0.66]). Conclusions: The findings of our systematic review and meta-analysis do not support the hypothesis that statins reduce the risk of including RTIs. (Figure Presented).