Atorvastatin Reduces the Severity of COVID-19: A Nationwide, Total Population-Based, Case-Control Study

Background: Statins have a pleiotropic effect in addition to a lipid-lowering effect. Several studies have demonstrated that statins may reduce the mortality and severity of infectious diseases, such as pneumonia or sepsis. We investigated the protective effects of various statins on the coronavirus disease 2019 (COVID-19) using a population-based cohort covering the entire Korean population. Methods: Consecutive patients diagnosed with COVID-19 between January 2020 and May 2020 were enrolled from the Korean National Health Insurance Service database. Current statin users were defined as patients who used statins within 30 days before the diagnosis of COVID-19. We compared the mortality and severity of COVID-19 between statin users and non-users to confirm the efficacy of statins. Results: Of the 7723 patients with COVID-19 who were enrolled, 255 died due to COVID-19 and 493 had severe COVID-19 (defined as mortality, admission to the intensive care unit, or mechanical ventilator use). Compared with non-users, atorvastatin users had a lower risk of COVID-19 mortality (odds ratio [OR], 0.54; 95% confidence interval [CI], 0.34-0.86) and severe COVID-19 (OR, 0.65; 95% CI, 0.45-0.93). However, other statins did not reduce the COVID-19 mortality and severity. Conclusions: Among the statins, only atorvastatin was effective in reducing the COVID-19 mortality and severity. Further randomized controlled trials are required to clarify the protective effects of atorvastatin.