Asiimwe, Innocent G 
ORCID: 0000-0002-1196-1822, Pushpakom, Sudeep ORCID: 0000-0002-6682-4235, Turner, Richard M ORCID: 0000-0002-7315-679X, Kolamunnage-Dona, Ruwanthi ORCID: 0000-0003-3886-6208, Jorgensen, Andrea L ORCID: 0000-0002-6977-9337 and Pirmohamed, Munir ORCID: 0000-0002-7534-7266
(2021)
Cardiovascular drugs and COVID-19 clinical outcomes: A living systematic review and meta-analysis.
BRITISH JOURNAL OF CLINICAL PHARMACOLOGY, 87 (12).
4534-+.
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bcp.14927.pdf - Author Accepted Manuscript Download (2MB) | Preview |
Abstract
<h4>Aims</h4>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.<h4>Methods</h4>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.<h4>Results</h4>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.<h4>Conclusion</h4>Cardiovascular drugs are not associated with poor COVID-19 outcomes in adjusted analyses. Patients should continue taking these drugs as prescribed.
| Item Type: | Article |
|---|---|
| Uncontrolled Keywords: | cardiovascular drugs, COVID-19, living systematic review, meta-analysis |
| Divisions: | Faculty of Health and Life Sciences Faculty of Health and Life Sciences > Institute of Population Health Faculty of Health and Life Sciences > Institute of Systems, Molecular and Integrative Biology |
| Depositing User: | Symplectic Admin |
| Date Deposited: | 11 Jun 2021 08:02 |
| Last Modified: | 18 Jan 2023 22:35 |
| DOI: | 10.1111/bcp.14927 |
| Related URLs: | |
| URI: | https://livrepository.liverpool.ac.uk/id/eprint/3125851 |
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