Cardiovascular drugs and COVID-19 clinical outcomes: a systematic review and meta-analysis of randomized controlled trials

Asiimwe, Innocent G ORCID: 0000-0002-1196-1822, Pushpakom, Sudeep P, 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 (2022) Cardiovascular drugs and COVID-19 clinical outcomes: a systematic review and meta-analysis of randomized controlled trials. BRITISH JOURNAL OF CLINICAL PHARMACOLOGY, 88 (8). pp. 3577-3599.

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Abstract

<h4>Aims</h4>To update our previously reported systematic review and meta-analysis of observational studies on cardiovascular drug exposure and COVID-19 clinical outcomes by focusing on newly published randomized controlled trials (RCTs).<h4>Methods</h4>More than 500 databases were searched between 1 November 2020 and 2 October 2021 to identify RCTs that were published after our baseline review. One reviewer extracted data with other reviewers verifying the extracted data for accuracy and completeness.<h4>Results</h4>After screening 22 414 records, we included 24 and 21 RCTs in the qualitative and quantitative syntheses, respectively. The most investigated drug classes were angiotensin-converting enzyme inhibitors (ACEIs)/angiotensin receptor blocker (ARBs) and anticoagulants, investigated by 10 and 11 studies respectively. In meta-analyses, ACEI/ARBs did not affect hospitalization length (mean difference -0.42, 95% confidence interval [CI] -1.83; 0.98 d, n = 1183), COVID-19 severity (risk ratio/RR 0.90, 95% CI 0.71; 1.15, n = 1661) or mortality (risk ratio [RR] 0.92, 95% CI 0.58; 1.47, n = 1646). Therapeutic anticoagulation also had no effect (hospitalization length mean difference -0.29, 95% CI -1.13 to 0.56 d, n = 1449; severity RR 0.86, 95% CI 0.70; 1.04, n = 2696; and, mortality RR 0.93, 95% CI 0.77; 1.13, n = 5689). Other investigated drug classes were antiplatelets (aspirin, 2 trials), antithrombotics (sulodexide, 1 trial), calcium channel blockers (amlodipine, 1 trial) and lipid-modifying drugs (atorvastatin, 1 trial).<h4>Conclusion</h4>Moderate- to high-certainty RCT evidence suggests that cardiovascular drugs such as ACEIs/ARBs are not associated with poor COVID-19 outcomes, and should therefore not be discontinued. These cardiovascular drugs should also not be initiated to treat or prevent COVID-19 unless they are needed for an underlying currently approved therapeutic indication.

Item Type:	Article
Uncontrolled Keywords:	cardiovascular drugs, COVID-19, living systematic review, meta-analysis, RCTs
Divisions:	Faculty of Health and Life Sciences Faculty of Health and Life Sciences > Institute of Systems, Molecular and Integrative Biology
Depositing User:	Symplectic Admin
Date Deposited:	31 Mar 2022 11:46
Last Modified:	19 Jan 2023 14:37
DOI:	10.1111/bcp.15331
Open Access URL:	https://doi.org/10.1111/bcp.15331
Related URLs:	Author Publisher
URI:	https://livrepository.liverpool.ac.uk/id/eprint/3151832