Renin-Angiotensin Aldosterone System Inhibitors in Primary Prevention and COVID-19.
Renin-Angiotensin Aldosterone System Inhibitors in Primary Prevention and COVID-19.
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DOI：
10.1161/jaha.120.021154
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发表时间：
2021-08-03
影响因子：
5.4
通讯作者：
Sundström J
中科院分区：
文献类型：
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作者：
Loader J;Lampa E;Gustafsson S;Cars T;Sundström J
考虑到先前研究中广泛存在的碰撞偏倚和适应症混淆的风险，肾素-血管紧张素-醛固酮系统(RAAS)抑制剂的使用与新冠肺炎之间的关联仍不清楚。因此，这项研究验证了RAAS抑制剂影响新冠肺炎的总和效应及其进展为严重结局的假设。这项全国性的队列研究比较了瑞典所有没有心血管疾病史的居民，他们使用RAAS抑制剂进行单一治疗(截至2020年1月1日)，以及使用钙通道阻滞剂或噻嗪利尿剂的居民。使用机器学习派生的倾向评分方法来平衡比较队列。在165355人(51%的女性)中，有367人因服用新冠肺炎而住院或死亡(使用RAAS抑制剂的246人，使用钙通道阻滞剂或噻嗪利尿剂的121人；COX比例风险比[HR]，0.97；95%的可信区间，0.74-1.27)。当单独评估每个结果时，有335人因新冠肺炎而住院(HR，0.92；95%CI，0.70-1.22)；死于新冠肺炎(HR，1.22；95%CI，0.68-2.19)。在使用RAAS抑制剂的患者和使用钙通道阻滞剂或噻嗪类利尿剂的患者中，新冠肺炎结果的严重性没有差异(有序Logistic回归优势比，1.01；95%CI，0.89-1.14)。尽管存在潜在的局限性，但这项研究是可用的最佳证据之一，表明在一级预防中使用RAAS抑制剂不会增加严重新冠肺炎后果的风险；提供了强有力的数据，科学家和政策制定者都可以根据这些数据更有信心地基于他们目前对新冠肺炎大流行期间使用RAAS抑制剂的安全性的立场。
Considering the widespread risk of collider bias and confounding by indication in previous research, the associations between renin‐angiotensin aldosterone system (RAAS) inhibitor use and COVID‐19 remain unknown. Accordingly, this study tested the hypothesis that RAAS inhibitors influence the summation effect of COVID‐19 and its progression to severe outcomes. This nationwide cohort study compared all residents of Sweden, without prior cardiovascular disease, in monotherapy (as of January 1, 2020) with a RAAS inhibitor to those using a calcium channel blocker or a thiazide diuretic. Comparative cohorts were balanced using machine‐learning‐derived propensity score methods. Of 165 355 people in the analysis (51% women), 367 were hospitalized or died with COVID‐19 (246 using a RAAS inhibitor versus 121 using a calcium channel blocker or thiazide diuretic; Cox proportional hazard ratio [HR], 0.97; 95% CI, 0.74–1.27). When each outcome was assessed separately, 335 people were hospitalized with COVID‐19 (HR, 0.92; 95% CI, 0.70–1.22), and 64 died with COVID‐19 (HR, 1.22; 95% CI, 0.68–2.19). The severity of COVID‐19 outcomes did not differ between those using a RAAS inhibitor and those using a calcium channel blocker or thiazide diuretic (ordered logistic regression odds ratio, 1.01; 95% CI, 0.89–1.14). Despite potential limitations, this study is among the best available evidence that RAAS inhibitor use in primary prevention does not increase the risk of severe COVID‐19 outcomes; presenting strong data from which scientists and policy makers alike can base, with greater confidence, their current position on the safety of using RAAS inhibitors during the COVID‐19 pandemic.