Abstract
COVID-19 (COronaVIrus Disease 2019) caused by the coronavirus SARS-CoV-2 infection has spread rapidly worldwide and, despite its relatively low mortality, is responsible for about 4 million deaths so far due to its high infectivity. Several interventions, whether prophylactic or symptomatic, are being retrospectively investigated.
SARS-CoV-2 enters cells using two pathways, either through the ACE2 receptor or through lipid rafts. The function of both can be influenced by statins, first choice drugs to lower plasma cholesterol levels.
Because ongoing statin therapy lowers not only plasma cholesterol, but also cholesterol levels in cell membranes and lipid rafts (their proper function depends on cholesterol availability) as well, statin therapy is discussed as COVID-19 treatment option. In opposite, however, experimental studies have shown that statins increase the concentration of ACE2 receptors - thus, statins could have also potential to facilitate virus entry into cells.
Observational studies have not reached a clear conclusion either, mainly because statin treated individuals are usually older and polymorbid and it is not easy to separate the effects of all confounding factors. However, the largest metaanalysis (almost 12 000 000 subjects included) performed so far, has not associated statins with lower risk of disease, disease severity or mortality.
Still, it is possible, that in some subgroups of patients (especially diabetics) concomitant use of statins could be profitable.