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Cardiovascular drugs and COVID-19 clinical outcomes: a living systematic review and meta-analysis
  • +3
  • Innocent Asiimwe,
  • Sudeep Pushpakon,
  • Richard Turner,
  • Ruwanthi Kolamunnage-Dona,
  • Andrea Jorgensen,
  • Munir Pirmohamed
Innocent Asiimwe
University of Liverpool
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Sudeep Pushpakon
University of Liverpool
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Richard Turner
University of Liverpool
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Ruwanthi Kolamunnage-Dona
University of Liverpool
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Andrea Jorgensen
University of Liverpool
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Munir Pirmohamed
University of Liverpool
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Abstract

Aims: To continually evaluate the role of cardiovascular drugs in COVID-19 clinical outcomes. Methods: Eligible publications were identified from >500 databases on 1-Nov-2020. One reviewer extracted data with 20% of the records independently extracted/evaluated by a second reviewer. Results: Of 52,735 screened records, 429 and 390 studies were included in the qualitative and quantitative syntheses, respectively. The most-reported drugs were angiotensin-converting enzyme inhibitors (ACEIs)/angiotensin receptor blockers (ARBs) with ACEI/ARB exposure having borderline association with positive COVID-19 status (OR 1.14, 95% CI 1.00–1.31). Among COVID-19 patients, unadjusted estimates showed that ACEI/ARB exposure was associated with hospitalization (OR 1.76, 1.34–2.32), disease severity (OR 1.41, 1.27–1.56) and all-cause mortality (OR 1.22, 1.12–1.33) but not hospitalization length (mean difference -0.27, -1.36; 0.82 days). After adjustment, ACEI/ARB exposure was not associated with positive COVID-19 status (OR 0.92, 0.71–1.19), hospitalization (OR 0.93, 0.70–1.24), disease severity (OR 1.05, 0.81–1.38), or all-cause mortality (OR 0.85, 0.71–1.01). Similarly, subgroup analyses involving only hypertensive patients revealed that ACEI/ARB exposure was not associated with positive COVID-19 status (OR 0.93, 0.79–1.09), hospitalization (OR 0.84, 0.58–1.22), hospitalization length (mean difference -0.14, -1.65; 1.36 days), disease severity (OR 0.92, 0.76–1.11) while it decreased the odds of dying (OR 0.76, 0.65–0.88). A similar trend was observed for other cardiovascular drugs. However, the validity of these findings is limited by a high level of heterogeneity and serious risk of bias. Conclusion: Cardiovascular drugs are not associated with poor COVID-19 outcomes in adjusted analyses. Patients should continue taking these drugs as prescribed.

Peer review status:ACCEPTED

24 Feb 2021Submitted to British Journal of Clinical Pharmacology
25 Feb 2021Submission Checks Completed
25 Feb 2021Assigned to Editor
28 Feb 2021Reviewer(s) Assigned
01 Apr 2021Review(s) Completed, Editorial Evaluation Pending
14 Apr 2021Editorial Decision: Revise Major
03 May 20211st Revision Received
04 May 2021Submission Checks Completed
04 May 2021Assigned to Editor
04 May 2021Review(s) Completed, Editorial Evaluation Pending
18 May 2021Editorial Decision: Accept