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Cardiovascular drugs and COVID‐19 clinical outcomes: A living systematic review and meta‐analysis

AIMS: The aim of this study was to continually evaluate the association between cardiovascular drug exposure and COVID‐19 clinical outcomes (susceptibility to infection, disease severity, hospitalization, hospitalization length, and all‐cause mortality) in patients at risk of/with confirmed COVID‐19...

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Autores principales: Asiimwe, Innocent G., Pushpakom, Sudeep, Turner, Richard M., Kolamunnage‐Dona, Ruwanthi, Jorgensen, Andrea L., Pirmohamed, Munir
Formato: Online Artículo Texto
Lenguaje:English
Publicado: John Wiley and Sons Inc. 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8239929/
https://www.ncbi.nlm.nih.gov/pubmed/34101232
http://dx.doi.org/10.1111/bcp.14927
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author Asiimwe, Innocent G.
Pushpakom, Sudeep
Turner, Richard M.
Kolamunnage‐Dona, Ruwanthi
Jorgensen, Andrea L.
Pirmohamed, Munir
author_facet Asiimwe, Innocent G.
Pushpakom, Sudeep
Turner, Richard M.
Kolamunnage‐Dona, Ruwanthi
Jorgensen, Andrea L.
Pirmohamed, Munir
author_sort Asiimwe, Innocent G.
collection PubMed
description AIMS: The aim of this study was to continually evaluate the association between cardiovascular drug exposure and COVID‐19 clinical outcomes (susceptibility to infection, disease severity, hospitalization, hospitalization length, and all‐cause mortality) in patients at risk of/with confirmed COVID‐19. METHODS: Eligible publications were identified from more than 500 databases on 1 November 2020. One reviewer extracted data with 20% of the records independently extracted/evaluated by a second reviewer. RESULTS: Of 52 735 screened records, 429 and 390 studies were included in the qualitative and quantitative syntheses, respectively. The most‐reported drugs were angiotensin‐converting enzyme inhibitors (ACEIs)/angiotensin receptor blockers (ARBs) with ACEI/ARB exposure having borderline association with confirmed COVID‐19 infection (OR 1.14, 95% CI 1.00–1.31). Among COVID‐19 patients, unadjusted estimates showed that ACEI/ARB exposure was associated with hospitalization (OR 1.76, 95% CI 1.34–2.32), disease severity (OR 1.40, 95% CI 1.26–1.55) and all‐cause mortality (OR 1.22, 95% CI 1.12–1.33) but not hospitalization length (mean difference −0.27, 95% CI −1.36–0.82 days). After adjustment, ACEI/ARB exposure was not associated with confirmed COVID‐19 infection (OR 0.92, 95% CI 0.71–1.19), hospitalization (OR 0.93, 95% CI 0.70–1.24), disease severity (OR 1.05, 95% CI 0.81–1.38) or all‐cause mortality (OR 0.84, 95% CI 0.70–1.00). Similarly, subgroup analyses involving only hypertensive patients revealed that ACEI/ARB exposure was not associated with confirmed COVID‐19 infection (OR 0.93, 95% CI 0.79–1.09), hospitalization (OR 0.84, 95% CI 0.58–1.22), hospitalization length (mean difference −0.14, 95% CI −1.65–1.36 days), disease severity (OR 0.92, 95% CI 0.76–1.11) while it decreased the odds of dying (OR 0.76, 95% CI 0.65–0.88). A similar trend was observed for other cardiovascular drugs. However, the validity of these findings is limited by a high level of heterogeneity and serious risk of bias. CONCLUSION: Cardiovascular drugs are not associated with poor COVID‐19 outcomes in adjusted analyses. Patients should continue taking these drugs as prescribed.
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spelling pubmed-82399292021-06-29 Cardiovascular drugs and COVID‐19 clinical outcomes: A living systematic review and meta‐analysis Asiimwe, Innocent G. Pushpakom, Sudeep Turner, Richard M. Kolamunnage‐Dona, Ruwanthi Jorgensen, Andrea L. Pirmohamed, Munir Br J Clin Pharmacol Meta‐analysis AIMS: The aim of this study was to continually evaluate the association between cardiovascular drug exposure and COVID‐19 clinical outcomes (susceptibility to infection, disease severity, hospitalization, hospitalization length, and all‐cause mortality) in patients at risk of/with confirmed COVID‐19. METHODS: Eligible publications were identified from more than 500 databases on 1 November 2020. One reviewer extracted data with 20% of the records independently extracted/evaluated by a second reviewer. RESULTS: Of 52 735 screened records, 429 and 390 studies were included in the qualitative and quantitative syntheses, respectively. The most‐reported drugs were angiotensin‐converting enzyme inhibitors (ACEIs)/angiotensin receptor blockers (ARBs) with ACEI/ARB exposure having borderline association with confirmed COVID‐19 infection (OR 1.14, 95% CI 1.00–1.31). Among COVID‐19 patients, unadjusted estimates showed that ACEI/ARB exposure was associated with hospitalization (OR 1.76, 95% CI 1.34–2.32), disease severity (OR 1.40, 95% CI 1.26–1.55) and all‐cause mortality (OR 1.22, 95% CI 1.12–1.33) but not hospitalization length (mean difference −0.27, 95% CI −1.36–0.82 days). After adjustment, ACEI/ARB exposure was not associated with confirmed COVID‐19 infection (OR 0.92, 95% CI 0.71–1.19), hospitalization (OR 0.93, 95% CI 0.70–1.24), disease severity (OR 1.05, 95% CI 0.81–1.38) or all‐cause mortality (OR 0.84, 95% CI 0.70–1.00). Similarly, subgroup analyses involving only hypertensive patients revealed that ACEI/ARB exposure was not associated with confirmed COVID‐19 infection (OR 0.93, 95% CI 0.79–1.09), hospitalization (OR 0.84, 95% CI 0.58–1.22), hospitalization length (mean difference −0.14, 95% CI −1.65–1.36 days), disease severity (OR 0.92, 95% CI 0.76–1.11) while it decreased the odds of dying (OR 0.76, 95% CI 0.65–0.88). A similar trend was observed for other cardiovascular drugs. However, the validity of these findings is limited by a high level of heterogeneity and serious risk of bias. CONCLUSION: Cardiovascular drugs are not associated with poor COVID‐19 outcomes in adjusted analyses. Patients should continue taking these drugs as prescribed. John Wiley and Sons Inc. 2021-07-07 2021-12 /pmc/articles/PMC8239929/ /pubmed/34101232 http://dx.doi.org/10.1111/bcp.14927 Text en © 2021 The Authors. British Journal of Clinical Pharmacology published by John Wiley & Sons Ltd on behalf of British Pharmacological Society. https://creativecommons.org/licenses/by-nc/4.0/This is an open access article under the terms of the http://creativecommons.org/licenses/by-nc/4.0/ (https://creativecommons.org/licenses/by-nc/4.0/) License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes.
spellingShingle Meta‐analysis
Asiimwe, Innocent G.
Pushpakom, Sudeep
Turner, Richard M.
Kolamunnage‐Dona, Ruwanthi
Jorgensen, Andrea L.
Pirmohamed, Munir
Cardiovascular drugs and COVID‐19 clinical outcomes: A living systematic review and meta‐analysis
title Cardiovascular drugs and COVID‐19 clinical outcomes: A living systematic review and meta‐analysis
title_full Cardiovascular drugs and COVID‐19 clinical outcomes: A living systematic review and meta‐analysis
title_fullStr Cardiovascular drugs and COVID‐19 clinical outcomes: A living systematic review and meta‐analysis
title_full_unstemmed Cardiovascular drugs and COVID‐19 clinical outcomes: A living systematic review and meta‐analysis
title_short Cardiovascular drugs and COVID‐19 clinical outcomes: A living systematic review and meta‐analysis
title_sort cardiovascular drugs and covid‐19 clinical outcomes: a living systematic review and meta‐analysis
topic Meta‐analysis
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8239929/
https://www.ncbi.nlm.nih.gov/pubmed/34101232
http://dx.doi.org/10.1111/bcp.14927
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