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Effect of Renin-Angiotensin-Aldosterone System Blockers on Adverse Outcomes in COVID-19 Patients
Poornima Vinod1, Vinod Krishnappa1, William Rathell1
1Department of Internal Medicine, University of North Carolina Health Southeastern, Lumberton, North Carolina, USA.
Introduction:
Angiotensin-converting enzyme 2 (ACE2) of the renin-angiotensin-aldosterone system (RAAS) serves as a functional receptor to gain entry into the cells for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which causes coronavirus disease 2019 (COVID-19). The interaction between SARS-CoV-2 and ACE2 is a potential virulent factor in infectivity. Our study aimed to ascertain the association of RAAS inhibitors with adverse cardiovascular and other outcomes in hospitalized COVID-19 patients.
Methods:
This is a retrospective study of medical records of ≥18-year-old patients hospitalized for COVID-19 from March 2020 to October 2020. Primary outcomes were acute cardiovascular events (ST-elevation myocardial infarction, non-ST-elevation myocardial infarction type 1, acute congestive heart failure, acute stroke) and mortality. Secondary outcomes were respiratory failure, need for and duration of mechanical ventilation, acute deep vein thrombosis or pulmonary embolism (DVT/PE), and readmission rate.
Results:
Among 376 hospitalized COVID-19 patients, 149 were on RAAS inhibitors. No statistically significant differences were found between RAAS inhibitor and non-RAAS inhibitor groups with respect to acute cardiovascular events (6% vs. 6.2%, p = 0.94), acute DVT/PE (4.7% vs. 4.8%, p = 0.97), hypoxia (62.4% vs. 58.6%, p = 0.46), need for mechanical ventilation (18.1% vs. 16.7%, p = 0.72), mortality (19.5% vs. 22%, p = 0.56), and readmission rate (11.4% vs. 14.1%, p = 0.45). Some nuances discovered were a higher rate of hospitalizations among Native Americans receiving RAAS inhibitors (30.2% vs. 19.8%) and significantly lower levels of procalcitonin in patients on RAAS inhibitors.
Conclusions:
Among hospitalized patients with COVID-19, those on RAAS inhibitors showed no significant differences in acute cardiovascular events, acute DVT/PE, hypoxia, need for mechanical ventilation, readmission, or mortality rate compared to those not on them. However, further large-scale studies are needed to validate these findings.
Insights
Patients on renin-angiotensin-aldosterone system (RAAS) inhibitors did not experience worse outcomes for cardiovascular events, blood clots, or mortality when hospitalized with COVID-19. These findings suggest RAAS inhibitors are safe for COVID-19 patients.
Area of Science:
- Cardiology
- Infectious Diseases
- Pharmacology
Background:
- Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) uses angiotensin-converting enzyme 2 (ACE2) for cell entry.
- The renin-angiotensin-aldosterone system (RAAS) plays a role in SARS-CoV-2 infectivity.
- Understanding the impact of RAAS inhibitors on COVID-19 outcomes is crucial.
Purpose of the Study:
- To investigate the association between RAAS inhibitors and adverse outcomes in hospitalized COVID-19 patients.
- To compare cardiovascular events, mortality, and other complications between patients on RAAS inhibitors and those not on them.
- To evaluate the safety of RAAS inhibitors in the context of COVID-19 infection.
Main Methods:
- Retrospective study of hospitalized COVID-19 patients (age ≥18) from March to October 2020.
- Primary outcomes included acute cardiovascular events and mortality.
- Secondary outcomes included respiratory failure, mechanical ventilation, deep vein thrombosis/pulmonary embolism (DVT/PE), and readmission rates.
Main Results:
- No significant differences in cardiovascular events, DVT/PE, hypoxia, mechanical ventilation, mortality, or readmission rates were observed between RAAS inhibitor and non-RAAS inhibitor groups.
- A higher hospitalization rate was noted among Native Americans on RAAS inhibitors.
- Lower procalcitonin levels were observed in patients taking RAAS inhibitors.
Conclusions:
- RAAS inhibitors were not associated with increased adverse cardiovascular events, DVT/PE, hypoxia, mechanical ventilation, mortality, or readmission in hospitalized COVID-19 patients.
- Further large-scale studies are warranted to confirm these findings.
- RAAS inhibitors appear safe for use in COVID-19 patients regarding major adverse outcomes.
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