Protecting older patients with cardiovascular diseases from COVID-19 complications using current medications

Abstract

Purpose In the pathogenesis of severe COVID-19 complications, derangements of renin–angiotensin–aldosterone system (RAAS), vascular endothelial dysfunction leading to inflammation and coagulopathy, and arrhythmias play an important role. Therefore, it is worth considering the use of currently available drugs to protect COVID-19 patients with cardiovascular diseases. Methods We review the current experience of conventional cardiovascular drugs [angiotensin-converting enzyme (ACE) inhibitors, angiotensin receptor blockers, anticoagulants, acetosalicylic acid, antiarrhythmic drugs, statins] as well as some other drug classes (antidiabetic drugs, vitamin D and NSAIDs) frequently used by older patients with cardiovascular diseases. Data were sought from clinical databases for COVID-19 and appropriate key words. Conclusions and recommendations are based on a consensus among all authors. Results Several cardiovascular drugs have a potential to protect patients with COVID-19, although evidence is largely based on retrospective, observational studies. Despite propensity score adjustments used in many analyses observational studies are not equivalent to randomised controlled trials (RCTs). Ongoing RCTs include treatment with antithrombotics, pulmonary vasodilators, RAAS-related drugs, and colchicine. RCTs in the acute phase of COVID-19 may not, however, recognise the benefits of long term anti-atherogenic therapies, such as statins. Conclusions Most current cardiovascular drugs can be safely continued during COVID-19. Some drug classes may even be protective. Age-specific data are scarce, though, and conditions which are common in older patients (frailty, comorbidities, polypharmacy) must be individually considered for each drug group.

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

“…Overall, our observation that the outpatient use of statins, ACEI/ARBs and anticoagulants were protective against adverse outcomes in patients diagnosed with COVID-19 is consistent with a review conducted by Alves et al 52 and previous studies that assessed premorbid use of these classes of cardiovascular medications. 53 , 54 , 55 , 56 , 57 It is important to note, that ours is, to our knowledge, the largest matched, national comparative analysis of cardiovascular medications and COVID-19 outcomes thus far.…”

Renin-Angiotensin-System Inhibitors Are Associated With Lower In-hospital Mortality in COVID-19 Patients Aged 80 and Older

“…Despite this large number of studies on this topic, only a few studies have been performed so far to investigate what happens at an older age (9), such as that of our study population (mean age: 87.4 ± 6.1 years). A French observational study, conducted in a geriatric department, showed a lower mortality rate in older patients (mean age: 86.3 ± 8.0 years) taking ACEi/ARB compared with patients not taking these drug classes (29).…”

“…After initial unfounded speculations questioning the safety of RASi in COVID-19, extensive literature has been published on this topic, disproving those initial fears and confirming either neutral or even protective effects of RASi on severity and mortality for COVID-19 (8). However, the clinical evidence in the older population, which is both the one most treated with RASi and the one most at risk for COVID-19 morbidity and mortality, is still scarce (8,9). Therefore, the aim of our study was to evaluate the association between RASi therapy and inhospital mortality in patients aged 80 years and older admitted for COVID-19.…”