Background SARS-CoV-2 (COVID-19) utilizes the angiotensin converting enzyme-2 (ACE-2) receptor to enter human cells. Angiotensin converting enzyme inhibitors (ACEI) and angiotensin II receptor antagonists (ARB) are associated with ACE-2 upregulation. We hypothesized that antecedent use of ACEI/ARB may be associated with mortality in COVID-19. Methods and Results We used the Coracle registry, which contains data of hospitalized COVID-19 patients in 4 regions of Italy, and restricted analyses to those ≥ 50 years of age. The primary outcome was in-hospital mortality. Among these 781 acutely ill patients, 133 (17.0%) used an ARB and 171 (21.9%) used an ACEI. While neither sex nor smoking status differed by user groups, patients on ACEI/ARB tended to be older and more likely to have hypertension, diabetes mellitus, and congestive heart failure. The overall mortality rate was 15.1% (118/781) and increased with age (PTrend < 0.0001). The crude odds ratios (ORs) for death for ACEI users and ARB users were 0.98, 95% confidence interval (CI): 0.60-1.60, p=0.9333, and 1.13, 95% CI: 0.67-1.91, p=0.6385, respectively. After adjusting for age, hypertension, diabetes mellitus, and congestive heart failure, antecedent ACEI administration was associated with reduced mortality (OR: 0.55, 95% CI: 0.31-0.98, p=0.0436); a similar, but weaker trend was observed for ARB administration (OR: 0.58, 95% CI: 0.32-1.07, p=0.0796). Conclusions In those aged ≥50 years hospitalized with COVID-19, antecedent use of ACEI was independently associated with reduced risk of inpatient death. Our findings suggest the protective role of renin-angiotensin-aldosterone system inhibition in patients with high cardiovascular risk affected by COVID-19.

Antecedent Administration of Angiotensin Converting Enzyme Inhibitors or Angiotensin II Receptor Antagonists and Survival After Hospitalization for SARS-CoV-2 (COVID-19) / A. Palazzuoli, M. Mancone, G.M. De Ferrari, G. Forleo, G.G. Secco, G.M. Ruocco, F. D'Ascenzo, S. Monticone, A. Paggi, M. Vicenzi, A.G. Palazzo, M. Landolina, E. Taravelli, G. Tavazzi, F. Blasi, F. Infusino, F. Fedele, F.G. De Rosa, M. Emmett, J.M. Schussler, K.M. Tecson, P.A. McCullough. - In: JOURNAL OF THE AMERICAN HEART ASSOCIATION. CARDIOVASCULAR AND CEREBROVASCULAR DISEASE. - ISSN 2047-9980. - (2020 Oct 07). [Epub ahead of print]

Antecedent Administration of Angiotensin Converting Enzyme Inhibitors or Angiotensin II Receptor Antagonists and Survival After Hospitalization for SARS-CoV-2 (COVID-19)

M. Vicenzi;F. Blasi;
2020-10-07

Abstract

Background SARS-CoV-2 (COVID-19) utilizes the angiotensin converting enzyme-2 (ACE-2) receptor to enter human cells. Angiotensin converting enzyme inhibitors (ACEI) and angiotensin II receptor antagonists (ARB) are associated with ACE-2 upregulation. We hypothesized that antecedent use of ACEI/ARB may be associated with mortality in COVID-19. Methods and Results We used the Coracle registry, which contains data of hospitalized COVID-19 patients in 4 regions of Italy, and restricted analyses to those ≥ 50 years of age. The primary outcome was in-hospital mortality. Among these 781 acutely ill patients, 133 (17.0%) used an ARB and 171 (21.9%) used an ACEI. While neither sex nor smoking status differed by user groups, patients on ACEI/ARB tended to be older and more likely to have hypertension, diabetes mellitus, and congestive heart failure. The overall mortality rate was 15.1% (118/781) and increased with age (PTrend < 0.0001). The crude odds ratios (ORs) for death for ACEI users and ARB users were 0.98, 95% confidence interval (CI): 0.60-1.60, p=0.9333, and 1.13, 95% CI: 0.67-1.91, p=0.6385, respectively. After adjusting for age, hypertension, diabetes mellitus, and congestive heart failure, antecedent ACEI administration was associated with reduced mortality (OR: 0.55, 95% CI: 0.31-0.98, p=0.0436); a similar, but weaker trend was observed for ARB administration (OR: 0.58, 95% CI: 0.32-1.07, p=0.0796). Conclusions In those aged ≥50 years hospitalized with COVID-19, antecedent use of ACEI was independently associated with reduced risk of inpatient death. Our findings suggest the protective role of renin-angiotensin-aldosterone system inhibition in patients with high cardiovascular risk affected by COVID-19.
SARS‐CoV‐2 (COVID‐19); angiotensin converting enzyme inhibitor; angiotensin converting enzyme‐2; hospitalization; mortality; renin‐angiotensin converting enzyme inhibitor
Settore MED/10 - Malattie dell'Apparato Respiratorio
Settore MED/11 - Malattie dell'Apparato Cardiovascolare
7-ott-2020
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Utilizza questo identificativo per citare o creare un link a questo documento: http://hdl.handle.net/2434/772075
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