Xu Ke, He Wu, Yu Bo, Zhong Kaineng, Zhou Da, Wang Dao Wen
Division of Cardiology, Department of Internal Medicine, Hubei Key Laboratory of Genetics and Molecular Mechanisms of Cardiological Disorders, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095# Jiefang Ave., Wuhan, 430030, China.
Health Commission of Hubei Provincial, Wuhan, 430079, China.
Cardiovasc Drugs Ther. 2025 Feb;39(1):63-74. doi: 10.1007/s10557-023-07494-5. Epub 2023 Aug 11.
The COVID-19 pandemic has become a serious global public health problem. Although the use of angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin II receptor type 1 blockers (ARBs) has been recommended in patients with COVID-19 and cardiovascular diseases (CVDs), according to the results of some small-sample retrospective analyses, there remains a lack of sufficient evidence to validate their efficacy. This multicenter retrospective study investigated whether ACEI/ARB administration was beneficial in patients with COVID-19 and CVDs.
A total of 11,231 patients with confirmed COVID-19 and CVDs, from 138 hospitals in Hubei Province, were included in this multicenter retrospective study. We compared the clinical characteristics and outcomes between the ARB and non-ARB groups and analyzed the risk factors for in-hospital death using univariate and multivariate Cox regression analyses and Kaplan-Meier curves.
In the multivariate Cox regression model, after adjusting for age, gender, comorbidities, and in-hospital medications, ARB use was associated with lower all-cause mortality (adjusted HR, 0.53; 95% CI, 0.38-0.73; P < 0.001). After propensity score-matched analysis, the adjusted HR for the use of ARB associated with all-cause mortality was 0.62 (95% CI, 0.40-0.88; P = 0.02). Further subgroup analyses found that the adjusted HRs for the use of ARB associated with all-cause mortality were 0.52 (95% CI, 0.30-0.89; P = 0.016), 0.37 (95% CI, 0.21-0.64; P < 0.001), 0.42 (95% CI, 0.28-0.64; P < 0.001), and 0.55 (95% CI, 0.37-0.84; P = 0.005) in patients with heart failure, diabetes, and hypercholesterolemia, and severe COVID-19, respectively.
ARB administration was significantly associated with a lower risk of all-cause mortality in patients with COVID-19 and CVDs.
ClinicalTrials.gov NCT05615792. https://www.
gov/ct2/show/NCT05615792.
新型冠状病毒肺炎（COVID-19）大流行已成为严重的全球公共卫生问题。尽管对于COVID-19合并心血管疾病（CVD）的患者，推荐使用血管紧张素转换酶抑制剂（ACEI）和血管紧张素II 1型受体阻滞剂（ARB），但根据一些小样本回顾性分析结果，仍缺乏足够证据证实其疗效。这项多中心回顾性研究调查了ACEI/ARB给药对COVID-19合并CVD患者是否有益。
本多中心回顾性研究纳入了湖北省138家医院的11231例确诊COVID-19合并CVD的患者。我们比较了ARB组和非ARB组的临床特征和结局，并使用单因素和多因素Cox回归分析以及Kaplan-Meier曲线分析了院内死亡的危险因素。
在多因素Cox回归模型中，调整年龄、性别、合并症和院内用药后，使用ARB与较低的全因死亡率相关（调整后风险比[HR]，0.53；95%置信区间[CI]，0.38-0.73；P<0.001）。倾向得分匹配分析后，使用ARB与全因死亡率相关的调整后HR为0.62（95%CI，0.40-0.88；P=0.02）。进一步的亚组分析发现，在心力衰竭、糖尿病、高胆固醇血症和重症COVID-19患者中，使用ARB与全因死亡率相关的调整后HR分别为0.52（95%CI，0.30-0.89；P=0.016）、0.37（95%CI，0.21-0.64；P<0.0）、0.42（95%CI，0.28-0.64；P<0.001）和0.55（95%CI，0.37-0.84；P=0.005）。
ARB给药与COVID-19合并CVD患者较低的全因死亡风险显著相关。
ClinicalTrials.gov NCT05615792。https://www.CLINICALTRIALS.gov/ct2/show/NCT05615792。
