The Potential Role of Statins in Infective Endocarditis: A Meta-Analysis

INTRODUCTION: Statins exhibit pleiotropic effects with potential benefits in several infectious diseases, but their role in infective endocarditis (IE) remains unclear. We evaluated the impact of statin use on the frequency of IE and on key clinical outcomes in patients with IE, specifically embolic events (EE) and mortality. METHODS: We conducted a meta-analysis in which the primary outcome was the frequency of IE among statin users compared with non-users. Secondary outcomes included EE and follow-up mortality (6 months to 1 year). RESULTS: Eleven observational studies, eight retrospective and three prospective, were included, comprising a total of 35,844 patients. The frequency of IE was significantly lower in patients receiving statins compared with non-users (odds ratio (OR): 0.52; 95% confidence interval (CI): 0.34-0.80; P=0.003). Statin-treated IE patients also had fewer EE than non-users (OR: 0.50; 95% CI: 0.26-0.96; P=0.04). Follow-up mortality was significantly reduced in IE patients using statins compared with non-users (hazard ratio (HR): 0.70; 95% CI: 0.61-0.80; P<0.00001). DISCUSSION: Statins exert anti-inflammatory, endothelial-stabilizing, and antithrombotic effects that counteract key pathological mechanisms underlying IE. In this meta-analysis, statin use was associated with a lower frequency of IE, fewer EE, and reduced follow-up mortality. CONCLUSION: This meta-analysis suggests that statins may offer protective benefits against the incidence of IE and its complications. However, these findings should be interpreted with caution and highlight the need for further research.