Renin-Angiotensin-Aldosterone System Blockers Are Not Associated With Coronavirus Disease 2019 (COVID-19) Hospitalization: Study of 1,439 UK Biobank Cases

Zahra Raisi-Estabragh; Celeste McCracken; Maddalena Ardissino; Mae S Bethell; Jackie Cooper; Cyrus Cooper; Nicholas C Harvey; Steffen E Petersen

doi:10.3389/fcvm.2020.00138

Renin-Angiotensin-Aldosterone System Blockers Are Not Associated With Coronavirus Disease 2019 (COVID-19) Hospitalization: Study of 1,439 UK Biobank Cases

Front Cardiovasc Med. 2020 Jul 14:7:138. doi: 10.3389/fcvm.2020.00138. eCollection 2020.

Authors

Zahra Raisi-Estabragh^{1

2}, Celeste McCracken¹, Maddalena Ardissino³, Mae S Bethell⁴, Jackie Cooper¹, Cyrus Cooper^{5

6}, Nicholas C Harvey^{5

6}, Steffen E Petersen^{1

2}

Affiliations

¹ NIHR Barts Biomedical Research Centre, William Harvey Research Institute, Queen Mary University of London, London, United Kingdom.
² Barts Heart Centre, St. Bartholomew's Hospital, Barts Health NHS Trust, London, United Kingdom.
³ Sir Alexander Fleming Building, Imperial College London, London, United Kingdom.
⁴ North West Anglia NHS Foundation Trust, Hinchingbrooke Hospital, Huntingdon, United Kingdom.
⁵ MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, United Kingdom.
⁶ NIHR Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, University of Southampton, Southampton, United Kingdom.

Abstract

Background: Cardiometabolic morbidity and medications, specifically Angiotensin Converting Enzyme inhibitors (ACEi) and Angiotensin Receptor Blockers (ARBs), have been linked with adverse outcomes from coronavirus disease 2019 (COVID-19). This study aims to investigate, factors associated with COVID-19 positivity in hospital for 1,436 UK Biobank participants; compared with individuals who tested negative, and with the untested, presumed negative, rest of the cohort. Methods: We studied 7,099 participants from the UK Biobank who had been tested for COVID-19 in hospital. We considered the following exposures: age, sex, ethnicity, body mass index (BMI), diabetes, hypertension, hypercholesterolaemia, ACEi/ARB use, prior myocardial infarction (MI), and smoking. We undertook comparisons between (1) COVID-19 positive and COVID-19 negative tested participants; and (2) COVID-19 tested positive and the remaining participants (tested negative plus untested, n = 494,838). Logistic regression models were used to investigate univariate and mutually adjusted associations. Results: Among participants tested for COVID-19, Black, Asian, and Minority ethnic (BAME) ethnicity, male sex, and higher BMI were independently associated with a positive result. BAME ethnicity, male sex, greater BMI, diabetes, hypertension, and smoking were independently associated with COVID-19 positivity compared to the remaining cohort (test negatives plus untested). However, similar associations were observed when comparing those who tested negative for COVID-19 with the untested cohort; suggesting that these factors associate with general hospitalization rather than specifically with COVID-19. Conclusions: Among participants tested for COVID-19 with presumed moderate to severe symptoms in a hospital setting, BAME ethnicity, male sex, and higher BMI are associated with a positive result. Other cardiometabolic morbidities confer increased risk of hospitalization, without specificity for COVID-19. ACE/ARB use did not associate with COVID-19 status.

Keywords: Angiotensin Converting Enzyme inhibitors; Angiotensin Receptor Blockers; UK Biobank; cardiometabolic disease; coronavirus disease 2019; ethnicity; obesity; sex.

Abstract

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