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Renin-Angiotensin-Aldosterone System Blockers and the Risk of Covid-19
Giuseppe Mancia1, Federico Rea1, Monica Ludergnani1
1From the University of Milano-Bicocca (G.M.), the National Center of Healthcare Research and Pharmacoepidemiology (F.R., G.C.) and the Unit of Biostatistics, Epidemiology, and Public Health, Department of Statistics and Quantitative Methods (F.R., G.C.), University of Milano-Bicocca, Azienda Regionale per l'Innovazione e gli Acquisti (M.L.), and Fondazione IRCCS Istituto Nazionale dei Tumori (G.A.), Milan, and Policlinico di Monza, Monza (G.M.) - all in Italy.
Insights
This study found no link between angiotensin-receptor blockers (ARBs) or angiotensin-converting-enzyme (ACE) inhibitors and COVID-19 risk. Higher use in COVID-19 patients was due to existing cardiovascular conditions, not drug effects.
Area of Science:
- Cardiology
- Infectious Diseases
- Pharmacology
Background:
- The relationship between angiotensin-receptor blockers (ARBs) and angiotensin-converting-enzyme (ACE) inhibitors and coronavirus disease 2019 (COVID-19) risk requires further investigation.
- Cardiovascular disease prevalence is higher in COVID-19 patients, necessitating clarity on medication impacts.
Purpose of the Study:
- To investigate the association between ARBs and ACE inhibitors use and the risk of developing COVID-19.
- To determine if these medications influence the severity or outcome of COVID-19.
Main Methods:
- A population-based case-control study was conducted in Italy's Lombardy region.
- 6,272 confirmed COVID-19 cases were matched with 30,759 controls.
- Logistic regression analysis adjusted for confounders was used to estimate odds ratios and 95% confidence intervals.
Main Results:
- Use of ARBs and ACE inhibitors was more common in COVID-19 cases than controls, correlating with higher rates of cardiovascular disease.
- No significant association was found between ARBs or ACE inhibitors and COVID-19 risk overall (aOR 0.95 and 0.96, respectively).
- No association was observed for severe or fatal COVID-19 cases (aOR 0.83 and 0.91 for ARBs and ACE inhibitors, respectively).
Conclusions:
- The increased use of ARBs and ACE inhibitors among COVID-19 patients is attributed to underlying cardiovascular conditions, not an increased risk of infection.
- This study provides no evidence that ARBs or ACE inhibitors affect the risk or severity of COVID-19.
Background:
A potential association between the use of angiotensin-receptor blockers (ARBs) and angiotensin-converting-enzyme (ACE) inhibitors and the risk of coronavirus disease 2019 (Covid-19) has not been well studied.
Methods:
We carried out a population-based case-control study in the Lombardy region of Italy. A total of 6272 case patients in whom infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was confirmed between February 21 and March 11, 2020, were matched to 30,759 beneficiaries of the Regional Health Service (controls) according to sex, age, and municipality of residence. Information about the use of selected drugs and patients' clinical profiles was obtained from regional databases of health care use. Odds ratios and 95% confidence intervals for associations between drugs and infection, with adjustment for confounders, were estimated by means of logistic regression.
Results:
Among both case patients and controls, the mean (±SD) age was 68±13 years, and 37% were women. The use of ACE inhibitors and ARBs was more common among case patients than among controls, as was the use of other antihypertensive and non-antihypertensive drugs, and case patients had a worse clinical profile. Use of ARBs or ACE inhibitors did not show any association with Covid-19 among case patients overall (adjusted odds ratio, 0.95 [95% confidence interval {CI}, 0.86 to 1.05] for ARBs and 0.96 [95% CI, 0.87 to 1.07] for ACE inhibitors) or among patients who had a severe or fatal course of the disease (adjusted odds ratio, 0.83 [95% CI, 0.63 to 1.10] for ARBs and 0.91 [95% CI, 0.69 to 1.21] for ACE inhibitors), and no association between these variables was found according to sex.
Conclusions:
In this large, population-based study, the use of ACE inhibitors and ARBs was more frequent among patients with Covid-19 than among controls because of their higher prevalence of cardiovascular disease. However, there was no evidence that ACE inhibitors or ARBs affected the risk of COVID-19.
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