Statins remain our safest and most effective drug for primary and secondary prevention of coronary artery disease. However, a cult of statin deniers has taken hold on the internet and their efforts often result in patients inappropriately stopping statins, an outcome which can have lethal consequences.
Early in the pandemic a patient of mine in his late 80s who had been successfully maintained for a decade on medical therapy for a totally occluded left anterior descending coronary artery presented with chest pain to a hospital ER. Testing revealed he had suffered a non ST elevation myocardial infarction and a subsequent catheterization showed a 99% blockage of his right coronary artery which was successfully stented.
When I reviewed his labs I noted that his LDL cholesterol which had been at goal for 10 years on statin therapy had doubled since we last checked it. It turns out the patient had stopped his statin (after 10 years of side-effect-free usage) 3 months earlier (without telling me) because a family member had told him the drug was dangerous.
Misinformation is even more rampant since the onset of COVID-19 and there has been much speculation that statins might worsen outcomes of the disease thus we may anticipate even more well-intentioned advice to patients to stop their prescribed medications.
COVID-19 and the Heart
COVID-19 compared to other respiratory viruses seems to be associated with more significant cardiovascular complications. Proposed mechanisms include inflammation, myocardial injury and thrombosis.
In addition, patients most likely to suffer severe COVID-19 are those with pre-existing cardiovascular disease who benefit most from statins.
Could Statins Reduce COVID-19 Risks?
Theoretically, statins could be cardioprotective in COVID-19 due to their effects on lipid-lowering and plaque stabilization along with documented anti-inflammatory, immunomodulatory and antithrombotic effects. In addition, statins inhibit a pathway (MYD88) which in SARS-CoV 1 was associated with intense inflammation and poor response.
Observational Data Show Statin Benefit
Fortunately, the observational data in this area strongly show that taking statins is associated with a lower risk of fatal or severe COVID-19. A large retrospective study of 14 thousand COVID-19 cases from China showed a 42% lower death rate in statin users compared to propensity-matched non-users.
(What any of this has to do with surfing is unclear to me.)
This study also showed that the benefit of statins may be mediated by reduced inflammation as inflammatory markers (CRP, IL-6 and WBC count) were significantly lower in statin users.
The latest evidence on this topic comes from a meta-analysis published Aug 4 in the American Journal of Cardiology which suggested a reduction in fatal or severe disease by 30% in those taking statins versus non-statin takers.
Like all observational data, we must view these findings as preliminary. At a minimum though we can take comfort that there is no signal that statins worsen COVID-19.
If you were on the fence about taking statins that were appropriately recommended to you I would strongly advise beginning them now.
Don’t, however, start statins based on these findings if you have no other indication for them.
As my patient’s case illustrates it is more important than ever during COVID-19 to continue to take appropriately prescribed statin drugs. If you think you are having statin-related side effects it is crucial to discuss the pros and cons of a trial off statins with your physician before stopping them.
N.B. The nice graphics in this post come from an ACC presentation by Dr. Erin Michos which can be viewed here