Associations of statin use with 30-day adverse outcomes among 4 801 406 US Veterans with and without SARS-CoV-2: an observational cohort study

• Published in: BMJ open Vol. 12; no. 3; p. e058363
• Main Authors: Wander, Pandora L, Lowy, Elliott, Beste, Lauren A, Tulloch-Palomino, Luis, Korpak, Anna, Peterson, Alexander C, Kahn, Steven E, Danaei, Goodarz, Boyko, Edward J
• Format: Journal Article
• Language: English
• Published: England British Medical Journal Publishing Group 18.03.2022; BMJ Publishing Group LTD; BMJ Publishing Group
• Series: Original research
• Subjects: Age; Alcohol use; Body mass index; Cohort analysis; Cohort Studies; Coronaviruses; COVID-19; Diabetes; epidemiology; Ethnicity; FDA approval; Heart failure; Hospitalization; Humans; Hydroxymethylglutaryl-CoA Reductase Inhibitors - therapeutic use; Hypertension; internal medicine; Laboratories; Medical records; Mortality; Observational studies; Patients; Public Health; Retrospective Studies; SARS-CoV-2; Severe acute respiratory syndrome coronavirus 2; Statins; Veterans; United States > US; COVID-19; internal medicine; epidemiology
• ISSN: 2044-6055; 2044-6055
• DOI: 10.1136/bmjopen-2021-058363

ObjectiveTo estimate associations of statin use with hospitalisation, intensive care unit (ICU) admission and mortality at 30 days among individuals with and without a positive test for SARS-CoV-2.DesignRetrospective cohort study.SettingUS Veterans Health Administration (VHA).ParticipantsAll veterans receiving VHA healthcare with ≥1 positive nasal swab for SARS-CoV-2 between 1 March 2020 and 10 March 2021 (cases; n=231 154) and a comparator group of controls comprising all veterans who did not have a positive nasal swab for SARS-CoV-2 but who did have ≥1 clinical lab test performed during the same time period (n=4 570 252).Main outcomesAssociations of: (1) any statin use, (2) use of specific statins or (3) low-intensity/moderate-intensity versus high-intensity statin use at the time of positive nasal swab for SARS-CoV-2 (cases) or result of clinical lab test (controls) assessed from pharmacy records with hospitalisation, ICU admission and death at 30 days. We also examined whether associations differed between individuals with and without a positive test for SARS-CoV-2.ResultsAmong individuals who tested positive for SARS-CoV-2, statin use was associated with lower odds of death at 30 days (OR 0.81 (95% CI 0.77 to 0.85)) but not with hospitalisation or ICU admission. Associations were similar comparing use of each specific statin to no statin. Compared with low-/moderate intensity statin use, high-intensity statin use was not associated with lower odds of ICU admission or death. Over the same period, associations of statin use with 30-day outcomes were significantly stronger among individuals without a positive test for SARS-CoV-2: hospitalisation OR 0.79 (95% CI 0.77 to 0.80), ICU admission OR 0.86 (95% CI 0.81 to 0.90) and death 0.60 (95% CI 0.58 to 0.62; p for interaction all <0.001).ConclusionsAssociations of statin use with lower adverse 30-day outcomes are weaker among individuals who tested positive for SARS-CoV-2 compared with individuals without a positive test, indicating that statins do not exert SARS-CoV-2 specific effects.