Pandemic of coronavirus disease 2019 (COVID-19), caused by the spread of the acute acute respiratory coronavirus 2 (SARS-CoV-2) syndrome, is driven by the emergence of new and more mobile changes . Long-term mortality and morbidity are known to be triggered by the cytokine storm that is most commonly seen in patients with severe and acute COVID-19.
Much attention has been focused on ways to reduce the lethal reduction of normal inflammatory reactions to this pathogen. A new research paper has been posted to medRxiv* preprint server reports reduction of hyper-inflammatory onions after administration of statins, better known drugs for their use in lowering blood cholesterol levels, to patients with COVID-19.
With severe COVID-19 influenza, pro-inflammatory cytokines such as tumor necrosis factor (TNF), IL-6 and IL-1β are produced in response to the viral infection. As the disease progresses, systemic effects of these cytokines lead to increased vascular permeability, multi-organ failure and death.
Lipid metabolism is strongly suspected to play an important role in this inflammation because cytokines are lipid derivatives, and lipids are essential elements of the cell organs that help to introducing the virus and enabling further reproduction and rewriting.
High cholesterol levels in the liver have been shown to induce SARS-CoV-2 endocytosis into the host cell, allowing the establishment of an infection. Statins work by inhibiting the enzyme 3-hydroxy-3-methyl-glutaryl-CoA (HMG-CoA) reductase within the cells. This action not only inhibits an increase in the primary myeloid differentiation response 88 to the presence of the virus but leads to increased expression of the enzyme-linked immune molecule that converted angiotensin 2 (ACE2) to the cell organs.
Earlier inspections
Previous research suggested lower mortality due to statin use, but some studies reported conflicting results. An overview of the current literature is not required. The available meta-analyzes of statin use in COVID-19 patients do not report whether patients were given statins after hospitalization or whether these drugs were used beforehand.
The standard introduction of the studies conducted to date on this aspect of COVID-19 regulation is a meta-analysis.
Mortality reduced by statins
There were 12 comparative studies of COVID-19-induced mortality in statin users vs non-statin users. These showed that pre-hospital use of statins for this condition did not provide a lower mortality benefit. However, when COVID-19 patients were given post-hospitalization, the risk of death fell by 47%, with death rates falling by 43%, compared to non-patients. practice.
This difference was not found among COVID-19 patients who were more severely ill, requiring admission to an intensive care unit (ICU). If this group were excluded, the benefit for statin users among hospital patients in terms of mortality remained lower at 43%, with mortality rates falling by 36% .
The use of statin did not affect ICU admissions and the need for mechanical ventilation, whether before or after admission to the hospital.
What is the impact?
This rigorous meta-analysis reports more than 110,000 patients, making it the most powerful study now available. Using separate assessments for COVID-19 mortality and ICU admissions after statin administration resulted in specific risk assessments for these results as well.
The speculative design of all included studies precludes the expectation of comparative study and control groups (statin users and non-individuals, respectively). To compensate for this, the researchers compared altered risk ratios rather than unchanged incident rates.
The findings of this study appear to indicate that risk of death, ICU admission, and mechanical ventilation do not differ between statin users and those who used statins prior to hospitalization with COVID-19. . However, there are several explanations.
For one, patients are not always on statins after being hospitalized for COVID-19 because these drugs are not part of routine administration. Therefore, patients receiving these drugs in this condition are more likely to receive them as part of their treatment for high-grade cardiovascular events such as myocardial infarction due to COVID-19, coronary heart syndrome, or stroke.
This demonstrates the strong potential for a higher number of sick patients to be admitted to the statin user group after admission, which would be likely to get worse results anyway. Comparing this group with pre-existing statin users could yield a result of the potential protective link in statin use before hospitalization with better results.
On the other hand, many studies reporting prehospital statin use do not record follow-up after these drugs. An earlier study showed that up to 42% of patients stop taking these drugs after admission. This would concern analysis of the protective effect of statin use prior to admission for COVID-19.
At the same time, this could lead to incorrect links between statin use after admission and adverse outcomes by accounting for the administration of these drugs during the hospital stay.
Lack of lower mortality risk among ICU patients may suggest that the use of statins is most beneficial in the early stages of COVID-19-induced inflammation. This needs to be confirmed by wider studies, however.
Overall, the lower risk of death with statin use after admission appears to be underestimated since many of these patients were put on statins for other cardiovascular symptoms, which they are at higher risk of death. The findings therefore support continued statin use in patients who are already taking these drugs.
Further randomized controlled trials will be needed to understand the role of statins as a specific treatment to reduce COVID-19-related mortality.
* Important message
medRxiv publish preliminary scientific reports that are not peer-reviewed and, therefore, should not be seen as final, guiding health-related clinical practice / behavior, or be treated as information established.