COVID-19 outcomes in patients taking cardioprotective medications

PLoS One. 2022 Oct 10;17(10):e0275787. doi: 10.1371/journal.pone.0275787. eCollection 2022.

Abstract

Introduction: The coronavirus disease 2019 (COVID-19) caused a worldwide pandemic and has led to over five million deaths. Many cardiovascular risk factors (e.g. obesity or diabetes) are associated with an increased risk of adverse outcomes in COVID-19. On the other hand, it has been suggested that medications used to treat cardiometabolic conditions may have protective effects for patients with COVID-19.

Objectives: To determine whether patients taking four classes of cardioprotective medications-aspirin, metformin, renin angiotensin aldosterone system inhibitors (RAASi) and statins-have a lower risk of adverse outcomes of COVID-19.

Methods: We conducted a retrospective cohort study of primary care patients at a large integrated healthcare delivery system who had a positive COVID-19 test between March 2020 and March 2021. We compared outcomes of patients who were taking one of the study medications at the time of the COVID-19 test to patients who took a medication from the same class in the past (to minimize bias by indication). The following outcomes were compared: a) hospitalization; b) ICU admission; c) intubation; and d) death. Multivariable analysis was used to adjust for patient demographics and comorbidities.

Results: Among 13,585 study patients, 1,970 (14.5%) were hospitalized; 763 (5.6%) were admitted to an ICU; 373 (2.8%) were intubated and 720 (5.3%) died. In bivariate analyses, patients taking metformin, RAASi and statins had lower risk of hospitalization, ICU admission and death. However, in multivariable analysis, only the lower risk of death remained statistically significant. Patients taking aspirin had a significantly higher risk of hospitalization in both bivariate and multivariable analyses.

Conclusions: Cardioprotective medications were not associated with a consistent benefit in COVID-19. As vaccination and effective treatments are not yet universally accessible worldwide, research should continue to determine whether affordable and widely available medications could be utilized to decrease the risks of this disease.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aspirin
  • COVID-19 Drug Treatment*
  • COVID-19* / epidemiology
  • Hospitalization
  • Humans
  • Hydroxymethylglutaryl-CoA Reductase Inhibitors* / therapeutic use
  • Metformin*
  • Retrospective Studies
  • SARS-CoV-2

Substances

  • Hydroxymethylglutaryl-CoA Reductase Inhibitors
  • Metformin
  • Aspirin

Grants and funding

This research was funded in part by contract # ME-2019C1-15328 from Patient-Centered Outcomes Research Institute (http://www.pcori.org). The funder only provided financial support in the form of the authors’ (FJM, MS, AT) salaries and research materials and did not play any role in study design, data collection and analysis, decision to publish or preparation of the manuscript. Phase V Technologies did not provide any financial support for the study and did not play any role in study design, data collection and analysis, decision to publish or preparation of the manuscript. The specific roles of the study authors are articulated in the ‘author contributions’ section.