Table 4.

Hypothetical negative and positive statin mechanisms capable of influencing coronavirus disease 2019 (COVID-19) outcomes.

Negative mechanisms/concerns	Positive mechanisms
Enhancement of SARS-CoV-2 entry through increased cellular expression of ACE2 [11], [60]	Reduction of viral cellular entry through decreased cell membrane cholesterol content (antiviral activity) [63], [68]
Possible weakened leucocyte function [81]	ACE2-mediated conversion of angiotensin II to angiotensin [1], [2], [3], [4], [5], [6], [7], [60], [73]
Drug–drug interactions with antiviral agents [59]	Inhibition of SARS-CoV-2 main protease (Mpro) [62]
Increased risk of myopathies and rhabdomyolysis [82]	Modulation of autophagy [71]
Potential hepatotoxicity [35]	Anti-inflammatory effects [55]
	Immunomodulatory effects [64]
	Oxidative stress reduction [65]
	Antithrombotic and endothelial effects [69]
	Cardiovascular protection [8]

For more information, see Subir et al. [10]; SARS-CoV-2, severe acute respiratory syndrome coronavirus 2; ACE2, angiotensin-converting enzyme 2.