key: cord-0880687-35fbefwm authors: Strandberg, Timo E.; Kivimäki, Mika title: Increased mortality risk associated with statins in the CORONADO study date: 2021-03-17 journal: Diabetes Metab DOI: 10.1016/j.diabet.2021.101250 sha: d21bd6722c93233479b286b5cc1b05033b26ed40 doc_id: 880687 cord_uid: 35fbefwm nan This is a PDF file of an article that has undergone enhancements after acceptance, such as the addition of a cover page and metadata, and formatting for readability, but it is not yet the definitive version of record. This version will undergo additional copyediting, typesetting and review before it is published in its final form, but we are providing this version to give early visibility of the article. Please note that, during the production process, errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. Concerning our revision, we do not know what to do. We got reviewer comments, which were not about our letter to the Editor. I have sent emails about this to you, but got no answer. Please advice. Sincerely, Timo Strandberg, MD 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 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 [5] . 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 J o u r n a l P r e -p r o o f 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 J o u r n a l P r e -p r o o f 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 Routine use of statins and increased mortality related to COVID-19 in inpatients with type 2 diabetes: Results from the CORONADO study Statins and clinical outcomes with COVID-19: Meta-analyses of observational studies In-hospital use of statins is associated with a reduced risk of mortality among individuals with COVID-19 Outcomes of hospitalized COVID-19 patients by risk factors: Results from a United States hospital claims database Statin use and in-hospital mortality in diabetics with COVID-19 Risk factors for Covid-19-related mortality in people with type 1 and type 2 diabetes in England: a populationbased cohort study