HMG-CoA reductase inhibitors and COVID-19 mortality in Stockholm, Sweden: A registry-based cohort study

The relationship between statin treatment and Coronavirus Disease 2019 (COVID-19) mortality has been discussed due to the pleiotropic effects of statins on coagulation and immune mechanisms. However, available observational studies are hampered by study design flaws, resulting in substantial heterog...

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Bibliographic Details
Published in:PLoS medicine 2021-10, Vol.18 (10), p.e1003820-e1003820
Main Authors: Bergqvist, Rita, Ahlqvist, Viktor H, Lundberg, Michael, Hergens, Maria-Pia, Sundström, Johan, Bell, Max, Magnusson, Cecilia
Format: Article
Language:English
Subjects:
Anticoagulants
Antihypertensives
Clinical trials
Cohort analysis
Coronary artery disease
Coronaviruses
COVID-19
Dosage and administration
Drug development
Heart diseases
HMG-CoA reductase inhibitors
Housing
Hydroxymethylglutaryl-CoA reductase
Ischemia
Medicin och hälsovetenskap
Medicine and Health Sciences
Mortality
Observational studies
Pandemics
Patient outcomes
Regression analysis
Research and Analysis Methods
Risk groups
Statins
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Summary:The relationship between statin treatment and Coronavirus Disease 2019 (COVID-19) mortality has been discussed due to the pleiotropic effects of statins on coagulation and immune mechanisms. However, available observational studies are hampered by study design flaws, resulting in substantial heterogeneity and ambiguities. Here, we aim to determine the relationship between statin treatment and COVID-19 mortality. This cohort study included all Stockholm residents aged 45 or older (N = 963,876), followed up from 1 March 2020 until 11 November 2020. The exposure was statin treatment initiated before the COVID-19-pandemic, defined as recorded statin dispensation in the Swedish Prescribed Drug Register between 1 March 2019 and 29 February 2020. COVID-19-specific mortality was ascertained from the Swedish Cause of Death Registry. Hazard ratios (HRs) were calculated using multivariable Cox regression models. We further performed a target trial emulation restricted to initiators of statins. Statin treatment had a modest negative association with COVID-19 mortality. While this finding needs confirmation from randomized clinical trials, it supports the continued use of statin treatment for medical prevention according to current recommendations also during the COVID-19 pandemic.
ISSN:1549-1676
1549-1277
1549-1676
DOI:10.1371/journal.pmed.1003820