Cardiovascular drugs do not worsen COVID-19 outcomes

Use of cardiovascular medications does not lead to poor COVID-19 clinical outcomes among high-risk patients, such as those with hypertension, according to a study.

“Patients on cardiovascular drugs should continue taking their medications as is recommended worldwide for angiotensin-converting enzyme inhibitors (ACEIs)/angiotensin receptor blockers (ARBs),” the researchers said.

A living systematic review and meta-analysis was conducted to examine the link between cardiovascular drug exposure and COVID-19 outcomes (susceptibility to infection, disease severity, hospitalization, hospitalization length, and all-cause mortality) in patients at risk of/with confirmed COVID-19.

The researchers identified eligible publications from more than 500 databases on 1 November 2020. One reviewer extracted data, and a second reviewer evaluated 20 percent of the records independently. A total of 52,735 studies were screened, of which 429 and 390 were included in the qualitative and quantitative syntheses, respectively.

ACEIs/ARBs were the most reported drugs, and exposure to such medications showed a borderline association with confirmed COVID-19 infection (odds ratio [OR], 1.14, 95 percent confidence interval [CI], 1.00‒1.31). [Br J Clin Pharmacol 2021;87:4534-4545]

Among COVID-19 patients, unadjusted estimates revealed the association of ACEI/ARB exposure with hospitalization (OR, 1.76, 95 percent CI, 1.34‒2.32), disease severity (OR, 1.40, 95 percent CI, 1.26‒1.55), and all-cause mortality (OR, 1.22, 95 percent CI, 1.12‒1.22), but not hospitalization length (mean difference, ‒0.27 days, 95 percent CI, ‒1.36 to 0.82).

After adjustment, ACEI/ARB exposure no longer correlated with confirmed COVID-19 infection (OR, 0.92, 95 percent CI, 0.71‒1.19), hospitalization (OR, 0.93, 95 percent CI, 0.70‒1.24), disease severity (OR, 1.05, 95 percent CI, 0.81‒1.38), or all-cause mortality (OR, 0.84, 95 percent CI, 0.70‒1.00).

In subgroup analyses involving patients with hypertension, ACEI/ARB exposure was likewise not associated with confirmed COVID-19 infection (OR, 0.93, 95 percent CI, 0.79‒1.09), hospitalization (OR, 0.84, 95 percent CI, 0.58‒1.22), hospitalization length (mean difference, ‒0.14 days, 95 percent CI, ‒1.65 to 1.36), disease severity (OR, 0.92, 95 percent CI, 0.76‒1.11), but it reduced the odds of dying (OR, 0.76, 95 percent CI, 0.65‒0.88).

This trend was also noted for other cardiovascular medications. Anticoagulants and lipid-modifying drugs appeared protective against all-cause death, and this finding was similar to that of previous reports. However, the number of studies was small, and the adjusted odds/risk ratios were not statistically significant. [Am J Cardiol 2020;134:153-155; Rev Med Virol 2021;31:e2180]

Earlier studies have examined the potential mechanisms in which cardiovascular drugs can influence COVID-19 outcomes. [Br J Pharmacol 2020;177:4873-4886; J Thromb Haemost 2020;18:1094-1099; Circulation 2020;141:1648-1655; J Stroke Cerebrovasc Dis 2020;29:104949]

“For ACEIs/ARBs, [the current finding] is consistent with a recent randomized controlled trial (RCT),” the researchers said. “High-quality evidence in the form of more RCTs is urgently required and will be the focus of our next systematic review update.” [Lancet Respir Med 2021;9:275-284]

“The COVID-19 situation is extremely dynamic, and it is not possible to tell when we will be transitioning out of the living systematic review mode. Nevertheless, updating for up to 2 years is currently planned,” they added.