Outpatient atorvastatin use and severe COVID‐19 outcomes: A population‐based study

Evidence of the effect of statins on patients with coronavirus disease (2019) COVID-19 is inconsistent. The aim of this study was to evaluate the association between chronic use of statins—both overall and by active ingredient—and severe outcomes of COVID-19 (risk of hospitalization and mortality), progression to severe outcomes, and susceptibility to the virus. We conducted a population-based case–control study with data from electronic records to assess the risk of (1) hospitalization: cases were patients admitted due to COVID-19 and controls were subjects without COVID-19; (2) mortality: cases were hospitalized patients who died due to COVID-19 and controls were subjects without COVID-19; (3) progression: cases were hospitalized COVID-19 subjects and controls were nonhospitalized COVID-19 patients; and (4) susceptibility: cases were patients with COVID-19 (both hospitalized and nonhospitalized) and controls were subjects without COVID-19. We collected data on 2821 hospitalized cases, 26 996 nonhospitalized cases, and 52 318 controls. Chronic use of atorvastatin was associated with a decreased risk of hospitalization (adjusted odds ratios [aOR] = 0.83; 95% confidence interval [CI]: 0.74–0.92) and mortality (aOR = 0.70; 95% CI: 0.53–0.93), attributable in part to a lower risk of susceptibility to the virus (aOR = 0.91; 95% CI: 0.86–0.96). Simvastatin was associated with a reduced risk of mortality (aOR = 0.59; 95% CI: 0.40–0.87). The wide degree of heterogeneity observed in the estimated odds ratios (ORs) of the different statins suggests that there is no class effect. The results of this real-world study suggest that chronic use of atorvastatin (and to a lesser degree, of simvastatin) is associated with a decrease in risk of severe COVID-19 outcomesThe authors should like to thank the SERGAS General Healthcare Directorate for furnishing the data needed to conduct this study, DXC Technology for its work in extracting the study data, and Michael Benedict for reviewing and revising the English. This study was sponsored by the Carlos III Institute of Health via the “COV20/00470” project (cofunded by the European Regional Development Fund, “A way to make Europe”)S