COVID-19 outcomes in patients taking cardioprotective medications
Fritha J Morrison, Maxwell Su, Alexander Turchin
PLOS ONE, doi:10.1371/journal.pone.0275787
Introduction The coronavirus disease 2019 (COVID-19) caused a worldwide pandemic and has led to over five million deaths. Many cardiovascular risk factors (e.g. obesity or diabetes) are associated with an increased risk of adverse outcomes in COVID-19. On the other hand, it has been suggested that medications used to treat cardiometabolic conditions may have protective effects for patients with COVID-19.
Objectives To determine whether patients taking four classes of cardioprotective medications-aspirin, metformin, renin angiotensin aldosterone system inhibitors (RAASi) and statins-have a lower risk of adverse outcomes of COVID-19.
Methods We conducted a retrospective cohort study of primary care patients at a large integrated healthcare delivery system who had a positive COVID-19 test between March 2020 and March 2021. We compared outcomes of patients who were taking one of the study medications at the time of the COVID-19 test to patients who took a medication from the same class in the past (to minimize bias by indication). The following outcomes were compared: a) hospitalization; b) ICU admission; c) intubation; and d) death. Multivariable analysis was used to adjust for patient demographics and comorbidities.
Results Among 13,585 study patients, 1,970 (14.5%) were hospitalized; 763 (5.6%) were admitted to an ICU; 373 (2.8%) were intubated and 720 (5.3%) died. In bivariate analyses, patients taking metformin, RAASi and statins had lower risk of hospitalization, ICU admission and death. However, in multivariable analysis, only the lower risk of death remained statistically significant. Patients taking aspirin had a significantly higher risk of hospitalization in both bivariate and multivariable analyses.
Author Contributions Conceptualization: Alexander Turchin.
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'abstract': '<jats:sec id="sec001">\n'
'<jats:title>Introduction</jats:title>\n'
'<jats:p>The coronavirus disease 2019 (COVID-19) caused a worldwide pandemic and has led to '
'over five million deaths. Many cardiovascular risk factors (e.g. obesity or diabetes) are '
'associated with an increased risk of adverse outcomes in COVID-19. On the other hand, it has '
'been suggested that medications used to treat cardiometabolic conditions may have protective '
'effects for patients with COVID-19.</jats:p>\n'
'</jats:sec>\n'
'<jats:sec id="sec002">\n'
'<jats:title>Objectives</jats:title>\n'
'<jats:p>To determine whether patients taking four classes of cardioprotective '
'medications—aspirin, metformin, renin angiotensin aldosterone system inhibitors (RAASi) and '
'statins–have a lower risk of adverse outcomes of COVID-19.</jats:p>\n'
'</jats:sec>\n'
'<jats:sec id="sec003">\n'
'<jats:title>Methods</jats:title>\n'
'<jats:p>We conducted a retrospective cohort study of primary care patients at a large '
'integrated healthcare delivery system who had a positive COVID-19 test between March 2020 and '
'March 2021. We compared outcomes of patients who were taking one of the study medications at '
'the time of the COVID-19 test to patients who took a medication from the same class in the '
'past (to minimize bias by indication). The following outcomes were compared: a) '
'hospitalization; b) ICU admission; c) intubation; and d) death. Multivariable analysis was '
'used to adjust for patient demographics and comorbidities.</jats:p>\n'
'</jats:sec>\n'
'<jats:sec id="sec004">\n'
'<jats:title>Results</jats:title>\n'
'<jats:p>Among 13,585 study patients, 1,970 (14.5%) were hospitalized; 763 (5.6%) were '
'admitted to an ICU; 373 (2.8%) were intubated and 720 (5.3%) died. In bivariate analyses, '
'patients taking metformin, RAASi and statins had lower risk of hospitalization, ICU admission '
'and death. However, in multivariable analysis, only the lower risk of death remained '
'statistically significant. Patients taking aspirin had a significantly higher risk of '
'hospitalization in both bivariate and multivariable analyses.</jats:p>\n'
'</jats:sec>\n'
'<jats:sec id="sec005">\n'
'<jats:title>Conclusions</jats:title>\n'
'<jats:p>Cardioprotective medications were not associated with a consistent benefit in '
'COVID-19. As vaccination and effective treatments are not yet universally accessible '
'worldwide, research should continue to determine whether affordable and widely available '
'medications could be utilized to decrease the risks of this disease.</jats:p>\n'
'</jats:sec>',
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