Increased mortality risk associated with statins in the CORONADO study.

The Coronavirus SARS-CoV-2 and Diabetes Outcomes (CORONADO) study investigators reported an increase in mortality associated with ongoing statin treatment in 2449 inpatients with type 2 diabetes (T2D) during the coronavirus disease 2019 (COVID-19) pandemic [1]. Crude 7-day mortality rates were 12.8% among statin users and 9.8% among non-users (P = 0.02), with the corresponding percentages for 28-day mortality being 23.9% and 18.2%, respectively (P < 0.001). Calculated unadjusted odds ratios (ORs) based on these figures were 1.36 [95% confidence interval (CI): 1.06–1.76] and 1.41 (95% CI: 1.15–1.72).

This difference in mortality was not unexpected as the statin users were older (mean age: 72 and 70 years, respectively), had diabetes of longer duration (15 and 12 years, respectively), and more hypertension (87% and 74%, respectively), heart failure (14% and 10%, respectively) and chronic obstructive pulmonary disease (COPD; 12% and 8%, respectively), as well as more macrovascular (54% and 27%, respectively) and microvascular (50% and 41%, respectively) complications than non-users of statins. After propensity score matching, the reported 7-day and 28-day ORs for mortality risk were 1.74 (95% CI: 1.13–2.65) and 1.46 (95% CI: 1.08–1.95), respectively. Nevertheless, it is rather surprising that the mortality risk prevails, even despite higher point estimates after adjusting for patients who had more factors associated with poor COVID-19 prognosis.

Statin treatment has been shown to be beneficial in randomized controlled trials of particular patient groups, such as patients with diabetes, who are most at risk of COVID-19. In addition, the majority of analyses concerning mortality risk during COVID-19 have thus far indicated a beneficial or neutral effect of statin use [2]. Large studies from China [3] and the US [4], [5], for example, indicated a 12–46% reduced mortality risk among statin users, including those with diabetes, and a UK-wide analysis of 2.9 million patients with T2D (mean age: 70 years) found that the risk of death due to COVID-19 was 28% lower among statin users [6].

Thus, the unexpected statin mortality results so far from CORONADO may represent outlier findings and call for more detailed analyses of underlying factors.

Conflicts of interest

None.