Considerations for the use of statin therapy in coronavirus disease 2019 era

ABSTRACT

Background: Patients with cardiovascular disease (CVD) are at an increased risk of developing severe disease and mortality associated with coronavirus disease 2019 (COVID-19). Statins form the cornerstone of therapy for primary and secondary prevention of CVD. Objective: This review aims at exploring the possible advantages and the risks associated with the use of statins in patients with COVID-19. Methods: We searched the PubMed and Google Scholar databases until June 5, 2020, and reviewed the available literature on this topic. Results: Statins have been shown to improve outcomes in acute respiratory distress syndrome, which is one of the major causes of death in COVID-19. Statins exert many pleiotropic effects (anti-inflammatory, immunomodulatory effect, nitric oxide release, and effects on coagulation cascade), which would theoretically appear beneficial in COVID-19. Statins also increase angiotensin-converting enzyme 2 levels in animal models and can potentially reduce lung injury related to viral infections. Besides, the cardioprotective effects of statins can be beneficial in cardiovascular complications (e.g., acute myocardial infarction) of COVID-19. Nonetheless, there are concerns regarding the adverse effects associated with the use of statins in the setting of COVID-19, which can be simply avoided by dose modification and clinical monitoring. Conclusions: Statins appear to be beneficial in COVID-19 and may improve the outcome, but future-focused studies are needed before recommending their de novo use in COVID-19.