Abstract
Background Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) 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 coronavirus disease 2019 (COVID-19). Methods and Results We used the Coracle registry, which contains data of patients hospitalized with COVID-19 in 4 regions of Italy, and restricted analyses to those ≥50 years of age. The primary outcome was in-hospital mortality. Among these 781 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 were 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 ( P Trend <0.0001). The crude odds ratios (ORs) for death for ACEI users and ARB users were 0.98, 95% 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 a protective role of renin-angiotensin-aldosterone system inhibition in patients with high cardiovascular risk affected by COVID-19.
Keywords: COVID‐19; SARS‐CoV‐2; angiotensin‐converting enzyme inhibitor; angiotensin‐converting enzyme‐2; hospitalization; mortality; renin‐angiotensin converting enzyme inhibitor.
【저자키워드】 Mortality, Hospitalization, COVID‐19, SARS‐CoV‐2, angiotensin‐converting enzyme inhibitor, angiotensin‐converting enzyme‐2, renin‐angiotensin converting enzyme inhibitor., 【초록키워드】 COVID-19, coronavirus disease, SARS-CoV-2, coronavirus, Hospitalized, Diabetes Mellitus, Sex, Italy, hypertension, ACE-2, ARB, Region, cardiovascular risk, Patient, death, age, congestive heart failure, receptor, trend, angiotensin-converting enzyme-2, inhibitor, smoking status, patients, in-hospital mortality, ACEi, administration, Analysis, Odds ratio, acute respiratory syndrome, Older, Primary outcome, 95% CI, overall mortality, reduced risk, enzyme, human cells, protective role, upregulation, while, antagonist, Result, affected, reduced, groups, Coracle, patients hospitalized, with COVID-19, 【제목키워드】 COVID-19, Angiotensin II, angiotensin-converting enzyme inhibitor, antagonist, antecedent,