In a recent study published in PLUS ONEResearchers evaluated the outcomes of coronavirus disease 2019 (COVID-19) in patients taking four types of heart-protective medications.
background
COVID-19, caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), remains a significant public health threat. Individuals with cardiovascular disease risk factors such as obesity and diabetes have an increased risk of adverse outcomes from COVID-19. Specifically, older patients have a higher risk, possibly due to loss of intrinsic cardiac protective mechanisms and endothelial dysfunction. As such, it has been hypothesized that drugs that reduce the risk of cardiovascular disease may benefit patients with COVID-19.
Renin-angiotensin-aldosterone system inhibitors (RAASi) show anti-inflammatory effects and may prevent lung infection caused by CoV and other viruses. Statins have anticoagulant and anti-inflammatory effects, which may help reduce the severity of COVID-19. Besides, the diabetes drug, metformin, also reduces tumor necrosis factor (TNF)-α and inflammatory adipokines that contribute to disease severity in COVID-19. Furthermore, aspirin has antiplatelet and anti-inflammatory properties that may reduce the risk of adverse outcomes in COVID-19.
about studying
The current study examined associations between cardioprotective drugs (metformin, aspirin, statins, and RAASi) and adverse clinical outcomes in COVID-19. The study group consisted of adults with a confirmed diagnosis of COVID-19 who had at least one encounter with a Mass General Brigham primary care practice prior to diagnosis. Individuals were included if they tested positive for COVID-19 from March 2020 to March 2021.
The researchers set the indicator date as when the (first) sample that tested SARS-CoV-2-positive was collected. The primary outcome of the study was hospitalization within 1 month of a positive test. Secondary outcomes were admission to the intensive care unit (ICU), intubation during hospitalization, and all-cause mortality within three months.
Four cardioprotective drugs—aspirin, RAASi, statins, and metformin—were evaluated separately as predictive variables. Individuals with an active prescription for any of these drugs, when tested positive for SARS-CoV-2, were considered ‘exposed’. In contrast, individuals with previous prescriptions were the controls. Multiple logistic regression was performed to assess associations between use of cardioprotective medications and poor outcomes in COVID-19.
the findings
The study group consisted of 13,585 people with previous or active prescriptions. Statins were used by 8,891 patients, aspirin by 4,487 patients, RAASi by 8,342 patients, and metformin by 3,696 patients. Approximately 22% of participants (2941) had used no medications at the index date, 41.8% were on one medication, 23.9% were on two, 10.6% were on three, and 2.1% were using all four medications. The mean age of the participants was 62.5; The study group was predominantly female and obese.
Baseline characteristics differed between individuals using current and former medications. Patients with active prescriptions for RAASi, statins, or metformin had a lower Charlson comorbidity index (CCI) than those with previous prescriptions. Patients with previous prescriptions were younger than current users in the aspirin group but older in the RAASi and statin groups. Overall, 14.5% of patients were hospitalized. 5.6% required ICU, 2.8% required intubation, and 5.3% died.
Bivariate analyzes revealed that patients taking RAASi and statins had lower risks of hospitalization, ICU admission, and death. Only metformin intake was associated with a reduced risk of mortality. On the other hand, aspirin was associated with a higher risk of hospitalization and admission to the intensive care unit. In addition, multivariate analyzes showed associations between statin use, metformin, and RAASi with lower mortality risks. By contrast, aspirin use was associated with an increased risk of hospitalization.
Female gender has been linked to a lower risk of hospitalization and admission to the intensive care unit among metformin users. Higher BMI was associated with higher rates of hospitalization, admission to the intensive care unit, and risk of intubation in all subjects. High CCI scores and proteinuria were associated with an increased risk of all adverse outcomes in all patients. Secondary analyzes and sensitivity analyzes, which limited control groups to patients with adverse drug reactions, were consistent with the primary findings.
Conclusions
In summary, the study found no evidence of consistent benefits of using heart-protective medications in COVID-19 patients. However, several drugs were associated with reduced risk of death but not decreased hospitalization, ICU admission, or intubation risk.
Study limitations include 1) the nature of monitoring, 2) the inclusion of patients from a single healthcare delivery system, and the reduction in generalizability to the entire US or global population, and 3) the lack of inclusion of cardiac metabolic drugs such as sodium glucose cotransporter 2 inhibitors, peptide-like 1 agonists With glucagon, and anticoagulants, among others.
Originally published at San Jose News Bulletin
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