Association of Cardiovascular Medications With Adverse Outcomes in a Matched Analysis of a National Cohort of Patients With COVID-19

Leonard K Wang; Yong-Fang Kuo; Jordan Westra; Mukaila A Raji; Mohanad Albayyaa; Joseph Allencherril; Jacques Baillargeon

doi:10.1016/j.ajmo.2023.100040

Association of Cardiovascular Medications With Adverse Outcomes in a Matched Analysis of a National Cohort of Patients With COVID-19

Am J Med Open. 2023 Jun:9:100040. doi: 10.1016/j.ajmo.2023.100040. Epub 2023 Mar 22.

Authors

Leonard K Wang¹, Yong-Fang Kuo^{2

3}, Jordan Westra², Mukaila A Raji^{2

3}, Mohanad Albayyaa⁴, Joseph Allencherril^{5

6}, Jacques Baillargeon²

Affiliations

¹ John Sealy School of Medicine, University of Texas Medical Branch, Galveston.
² Department of Preventive Medicine and Population Health, University of Texas Medical Branch, Galveston.
³ Department of Internal Medicine, University of Texas Medical Branch, Galveston.
⁴ Institute for Translational Sciences, University of Texas Medical Branch.
⁵ Texas Heart Institute, Houston.
⁶ Section of Cardiology, Baylor College of Medicine, Houston, Texas.

Abstract

Background: The use of statins, angiotensin-converting enzyme inhibitors (ACEIs)/angiotensin II receptor blockers (ARBs), and anticoagulants may be associated with fewer adverse outcomes in COVID-19 patients.

Methods: Nested within a cohort of 800,913 patients diagnosed with COVID-19 between April 1, 2020 and June 24, 2021 from the Optum COVID-19 database, three case-control studies were conducted. Cases-defined as persons who: (1) were hospitalized within 30 days of COVID-19 diagnosis (n = 88,405); (2) were admitted to the intensive care unit (ICU)/received mechanical ventilation during COVID-19 hospitalization (n = 22,147); and (3) died during COVID-19 hospitalization (n = 2300)-were matched 1:1 using demographic/clinical factors with controls randomly selected from a pool of patients who did not experience the case definition/event. Medication use was based on prescription ≤90 days before COVID-19 diagnosis.

Results: Statin use was associated with decreased risk of hospitalization (adjusted odds ratio [aOR], 0.72; 95% confidence interval [95% CI], 0.69, 0.75) and ICU admission/mechanical ventilation (aOR, 0.90; 95% CI, 0.84, 0.97). ACEI/ARB use was associated with decreased risk of hospitalization (aOR, 0.67; 95% CI, 0.65, 0.70), ICU admission/mechanical ventilation (aOR, 0.92; 95% CI, 0.86, 0.99), and death (aOR, 0.60; 95% CI, 0.47, 0.78). Anticoagulant use was associated with decreased risk of hospitalization (aOR, 0.94; 95% CI, 0.89, 0.99) and death (aOR, 0.56; 95% CI, 0.41, 0.77). Interaction effects-in the model predicting hospitalization-were statistically significant for statins and ACEI/ARBs (P < .0001), statins and anticoagulants (P = .003), ACEI/ARBs and anticoagulants (P < .0001). An interaction effect-in the model predicting ventilator use/ICU-was statistically significant for statins and ACEI/ARBs (P = .002).

Conclusions: Statins, ACEI/ARBs, and anticoagulants were associated with decreased risks of the adverse outcomes under study. These findings may provide clinically relevant information regarding potential treatment for patients with COVID-19.

Keywords: Anticoagulants; COVID-19; Renin-angiotensin-aldosterone system blockers; Statins.

Grants and funding

UL1 TR001439/TR/NCATS NIH HHS/United States