Renin-Angiotensin-Aldosterone System Blockers and the Risk of Covid-19
Renin-Angiotensin-Aldosterone System Blockers and the Risk of Covid-19
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DOI：
10.1056/nejmoa2006923
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发表时间：
2020-06-18
影响因子：
158.5
通讯作者：
Corrao, Giovanni
中科院分区：
文献类型：
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作者：
Mancia, Giuseppe;Rea, Federico;Corrao, Giovanni
这项来自北方意大利的基于人群的病例对照研究显示，由于心血管疾病的患病率较高，ACE抑制剂和ARB的使用在新冠肺炎患者中更为频繁。然而，没有证据表明ACE抑制剂和ARB会影响Covid-19的风险。背景使用血管紧张素受体阻滞剂（ARB）和血管紧张素转换酶（ACE）抑制剂与2019冠状病毒病（Covid-19）风险之间的潜在关联尚未得到充分研究。方法我们在意大利伦巴第大区进行了一项基于人群的病例对照研究，共收集了6272例严重急性呼吸综合征冠状病毒2型感染患者，（SARS-CoV-2）在2020年2月21日至3月11日期间被确认，与区域卫生服务的30，759名受益人进行了匹配（对照）根据性别、年龄和居住地。从区域卫生保健使用数据库中获得有关选定药物使用和患者临床特征的信息。通过logistic回归估计药物和感染之间关联的比值比和95%置信区间，并调整混杂因素。结果在病例组和对照组中，平均（+/- SD）年龄为68 ± 13岁，37%为女性。ACE抑制剂和ARB的使用在病例患者中比对照组更常见，其他降压药和非降压药的使用也是如此，病例患者的临床特征更差。在所有病例患者中，ARB或ACE抑制剂的使用未显示与Covid-19有任何关联（ARB的校正比值比为0.95 [95%置信区间{CI}，0.86 - 1.05]，ACE抑制剂为0.96 [95% CI，0.87 - 1.07]）或在重度或致死性病程的患者中（ARB和ACE抑制剂的校正比值比分别为0.83 [95% CI，0.63 - 1.10]和0.91 [95% CI，0.69 - 1.21]），并且未发现这些变量之间存在性别相关性。结论：在这项基于人群的大型研究中，ACE抑制剂和ARB在COVID-19患者中的使用频率高于对照组，因为他们的心血管疾病患病率较高。然而，没有证据表明ACE抑制剂或ARB会影响COVID-19的风险。
This population-based case-control study from northern Italy shows that the use of ACE inhibitors and ARBs was more frequent among patients with Covid-19 because of a higher prevalence of cardiovascular disease. However, there was no evidence that ACE inhibitors and ARBs affected the risk of Covid-19.Background A potential association between the use of angiotensin-receptor blockers (ARBs) and angiotensin-converting-enzyme (ACE) inhibitors and the risk of coronavirus disease 2019 (Covid-19) has not been well studied. Methods We carried out a population-based case-control study in the Lombardy region of Italy.A total of 6272 case patients in whom infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was confirmed between February 21 and March 11, 2020, were matched to 30,759 beneficiaries of the Regional Health Service (controls) according to sex, age, and municipality of residence. Information about the use of selected drugs and patients' clinical profiles was obtained from regional databases of health care use. Odds ratios and 95% confidence intervals for associations between drugs and infection, with adjustment for confounders, were estimated by means of logistic regression. Results Among both case patients and controls, the mean (+/- SD) age was 68 +/- 13 years, and 37% were women. The use of ACE inhibitors and ARBs was more common among case patients than among controls, as was the use of other antihypertensive and non-antihypertensive drugs, and case patients had a worse clinical profile. Use of ARBs or ACE inhibitors did not show any association with Covid-19 among case patients overall (adjusted odds ratio, 0.95 [95% confidence interval {CI}, 0.86 to 1.05] for ARBs and 0.96 [95% CI, 0.87 to 1.07] for ACE inhibitors) or among patients who had a severe or fatal course of the disease (adjusted odds ratio, 0.83 [95% CI, 0.63 to 1.10] for ARBs and 0.91 [95% CI, 0.69 to 1.21] for ACE inhibitors), and no association between these variables was found according to sex. Conclusions In this large, population-based study, the use of ACE inhibitors and ARBs was more frequent among patients with Covid-19 than among controls because of their higher prevalence of cardiovascular disease. However, there was no evidence that ACE inhibitors or ARBs affected the risk of COVID-19.