Use of angiotensin converting enzyme inhibitors and angiotensin receptor blockers associated with lower risk of COVID-19 in household contacts

Armstrong, Katrina; Soltoff, Alexander; Rieu-Werden, Meghan L.; Metlay, Joshua P.; Haas, Jennifer S.

doi:10.1371/journal.pone.0247548

Cited by 9 publications

(7 citation statements)

References 23 publications

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“…Some studies have shown a significant association between ACEi or ARB use and risk of SARS-CoV-2 infection and severity of health outcomes. (14, 15) In contrast to that, our study did not find any association, positive or negative, between ACEi or ARB use and serostatus. This suggests that use of ACEi or ARB may not affect vaccine efficacy, even if their use has the potential to influence risk of disease or its severity.…”

Section: Discussioncontrasting

confidence: 99%

Pre-Existing Comorbidities Diminish the Likelihood of Seropositivity After SARS-CoV-2 Vaccination

Amraotkar

Bushau-Sprinkle

Keith

et al. 2022

Preprint

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Background: The impact of chronic health conditions (CHC) on serostatus post-severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccination is unknown. Methods: We assessed serostatus post-SARS-CoV-2 vaccination among fully vaccinated participants recruited between April 2021 through August 2021 in 18 years and older residents of Jefferson County, Kentucky, USA. Serostatus was determined by measuring SARS-CoV-2 Spike protein specific immunoglobulin (Ig) G (Spike IgG) antibodies via enzyme-linked immunoassay (ELISA) in peripheral blood samples. Results: Of the 5,178 fully vaccinated participants, 51 were seronegative and 5,127 were seropositive. Chronic kidney disease (CKD) (OR=13.49; 95% CI: 4.88, 37.3; P<0.0001) and autoimmune disease (OR=11.34; 95% CI: 5.21, 24.69; P<0.0001) showed highest association with negative serostatus in fully vaccinated participants. The absence of any CHC was strongly associated with positive serostatus (OR=0.37; 95% CI: 0.19, 0.73; P=0.003). The risk of negative serostatus increased in the presence of two CHCs (OR=2.82; 95% CI: 1.14, 7) to three or more CHCs (OR=4.52; 95% CI: 1.68, 12.14). Similarly, use of 2 or more CHC related medications was significantly associated with seronegative status (OR=6.08; 95%: 2.01, 18.35). Conclusions: Presence of any CHC, especially CKD or autoimmune disease, increased the likelihood of seronegative status among individuals who were fully vaccinated to SAR-CoV-2. This risk increased with a concurrent increase in number of comorbidities, especially with multiple medications. Absence of any CHC was protective and increased the likelihood of a positive serological response post-vaccination. These results will help develop appropriate guidelines for booster doses and targeted vaccination programs.

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Section: Discussioncontrasting

confidence: 99%

Pre-Existing Comorbidities Diminish the Likelihood of Seropositivity After SARS-CoV-2 Vaccination

Amraotkar

Bushau-Sprinkle

Keith

et al. 2022

Preprint

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“…The systematic search identified 169 observational studies that assessed the associations between RAAS inhibitor use and the risk of contracting a SARS‐CoV‐2 infection and/or experiencing severe COVID‐19 outcomes (Figure 1 ). 8 , 19 , 66 , 67 , 68 , 69 , 70 , 71 , 72 , 73 , 74 , 75 , 76 , 77 , 78 , 79 , 80 , 81 , 82 , 83 , 84 , 85 , 86 , 87 , 88 , 89 , 90 , 91 , 92 , 93 , 94 , 95 , 96 , 97 , 98 , 99 , 100 , 101 , 102 , 103 , 104 , 105 , 106 , 107 , 108 , 109 , 110 , 111 , 112 , 113 , …”

Section: Resultsmentioning

confidence: 99%

Renin‐Angiotensin Aldosterone System Inhibitors and COVID‐19: A Systematic Review and Meta‐Analysis Revealing Critical Bias Across a Body of Observational Research

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Taylor

Lampa

et al. 2022

JAHA

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Background Renin‐angiotensin aldosterone system (RAAS) inhibitor—COVID‐19 studies, observational in design, appear to use biased methods that can distort the interaction between RAAS inhibitor use and COVID‐19 risk. This study assessed the extent of bias in that research and reevaluated RAAS inhibitor—COVID‐19 associations in studies without critical risk of bias. Methods and Results Searches were performed in MEDLINE, EMBASE, and CINAHL databases (December 1, 2019 to October 21, 2021) identifying studies that compared the risk of infection and/or severe COVID‐19 outcomes between those using or not using RAAS inhibitors (ie, angiotensin‐converting enzyme inhibitors or angiotensin II type‐I receptor blockers). Weighted hazard ratios (HR) and 95% CIs were extracted and pooled in fixed‐effects meta‐analyses, only from studies without critical risk of bias that assessed severe COVID‐19 outcomes. Of 169 relevant studies, 164 had critical risks of bias and were excluded. Ultimately, only two studies presented data relevant to the meta‐analysis. In 1 351 633 people with uncomplicated hypertension using a RAAS inhibitor, calcium channel blocker, or thiazide diuretic in monotherapy, the risk of hospitalization (angiotensin‐converting enzyme inhibitor: HR, 0.76; 95% CI, 0.66–0.87; P <0.001; angiotensin II type‐I receptor blockers: HR, 0.86; 95% CI, 0.77–0.97; P =0.015) and intubation or death (angiotensin‐converting enzyme inhibitor: HR, 0.64; 95% CI, 0.48–0.85; P =0.002; angiotensin II type‐I receptor blockers: HR, 0.74; 95% CI, 0.58–0.95; P =0.019) with COVID‐19 was lower in those using a RAAS inhibitor. However, these protective effects are probably not clinically relevant. Conclusions This study reveals the critical risk of bias that exists across almost an entire body of COVID‐19 research, raising an important question: Were research methods and/or peer‐review processes temporarily weakened during the surge of COVID‐19 research or is this lack of rigor a systemic problem that also exists outside pandemic‐based research? Registration URL: www.crd.york.ac.uk/prospero/ ; Unique identifier: CRD42021237859.

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“…This study showed that the Probability of COVID-19 diagnosis was slightly higher among ACEI/ARB users. However, ACEI/ARB users were older and when the cohort was adjusted for age, gender, race/ethnicity, English proficiency, comorbid conditions, time period, including patients with documented hypertension, diabetes, or cardiovascular disease, as well as when including other medications in the models, use of ACEI/ARBs remained associated with a decreased risk of COVID-19 infection in propensity score analyses with a predicted probability of COVID infection 18.6% in ACEI/ARB users vs. 24.5% in non-users, p = 0.03 [8].…”

Section: Resultsmentioning

confidence: 99%

“…This theoretically should increase the risk of covid-19 transmission [16,19,24,30]. But some studies have shown that the use of ACE inhibitors and ARBs has soon reduced the risk of COVID-19 transmission and being symptomatically infected [8,21].…”

Section: Introductionmentioning

confidence: 99%

ACEI or not to ACEI: Review on using ACEI and ARBs on COVID-19 patients: Systemic review

Walia

2023

Preprint

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Purpose and motivation of this study: Angiotensin-converting enzyme inhibitors (ACEI) and Aldosterone receptor blockers (ARBs) are one most commonly used drugs for the treatment of cardiovascular disease among other comorbidities. As multiple studies have shown that covid virus binds to the ACE2 receptor for entry into the cell. ACEI and ARBs are shown to modulate the ACE2 receptor hence, it is important to see if there are any correlations between the use of medicine and the infectivity of COVID-19. The purpose of this study is to find if the use of ACEI /ARBs can in fact increase or decrease the spread of COVID-19. Method: This is a systemic review study during which all studies which helped us answer the question, of how the use of ACEI and ARBs can affect the transmission of the COVID-19 virus, were analyzed and reviewed to draw a conclusion about clinical safety and requirements of ACEI and ARBs in COVID-19 patients. Result: After a complete review of all the available data very conflicting results were found. Many studies showed an increase in the transmission of COVID-19 while others showed a decreased risk of COVID-19 transmission with ACEI and ARBs use. Both results were statistically significant. Conclusion: With these conflicting results the question we started with comes up again. Should we or should we not use ACEI & ARBs with covid patients? What should be the best clinical response with the use of ACEI & ARBs if it modulates transmission? To answer these, one must look not only at the statistically significant results of studies but also at the disease progression without ACEI & ARBs treatment regimes. Due to the small amount of data, there is currently no clear conclusive evidence to suggest that ACE inhibitors either increase or decrease the risk of COVID-19 transmission or the severity of the disease. Thus, more and larger studies should be developed to find a concrete answer. Until that these medicines should not be discontinued as the morbidities of cardiovascular diseases are high, and the use of ACEI and ARBs is central to the treatment.

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Use of angiotensin converting enzyme inhibitors and angiotensin receptor blockers associated with lower risk of COVID-19 in household contacts

Cited by 9 publications

References 23 publications

Pre-Existing Comorbidities Diminish the Likelihood of Seropositivity After SARS-CoV-2 Vaccination

Pre-Existing Comorbidities Diminish the Likelihood of Seropositivity After SARS-CoV-2 Vaccination

Renin‐Angiotensin Aldosterone System Inhibitors and COVID‐19: A Systematic Review and Meta‐Analysis Revealing Critical Bias Across a Body of Observational Research

ACEI or not to ACEI: Review on using ACEI and ARBs on COVID-19 patients: Systemic review

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