Angiotensin II receptor blocker intake associates with reduced markers of inflammatory activation and decreased mortality in patients with cardiovascular comorbidities and COVID-19 disease
Standard
Angiotensin II receptor blocker intake associates with reduced markers of inflammatory activation and decreased mortality in patients with cardiovascular comorbidities and COVID-19 disease. / Cremer, Sebastian; Pilgram, Lisa; Berkowitsch, Alexander; Stecher, Melanie; Rieg, Siegbert; Shumliakivska, Mariana; Bojkova, Denisa; Wagner, Julian Uwe Gabriel; Aslan, Galip Servet; Spinner, Christoph; Luxán, Guillermo; Hanses, Frank; Dolff, Sebastian; Piepel, Christiane; Ruppert, Clemens; Guenther, Andreas; Rüthrich, Maria Madeleine; Vehreschild, Jörg Janne; Wille, Kai; Haselberger, Martina; Heuzeroth, Hanno; Hansen, Arne; Eschenhagen, Thomas; Cinatl, Jindrich; Ciesek, Sandra; Dimmeler, Stefanie; Borgmann, Stefan; Zeiher, Andreas; LEOSS study group.
in: PLOS ONE, Jahrgang 16, Nr. 10, e0258684, 21.10.2021.Publikationen: SCORING: Beitrag in Fachzeitschrift/Zeitung › SCORING: Zeitschriftenaufsatz › Forschung › Begutachtung
Harvard
APA
Vancouver
Bibtex
}
RIS
TY - JOUR
T1 - Angiotensin II receptor blocker intake associates with reduced markers of inflammatory activation and decreased mortality in patients with cardiovascular comorbidities and COVID-19 disease
AU - Cremer, Sebastian
AU - Pilgram, Lisa
AU - Berkowitsch, Alexander
AU - Stecher, Melanie
AU - Rieg, Siegbert
AU - Shumliakivska, Mariana
AU - Bojkova, Denisa
AU - Wagner, Julian Uwe Gabriel
AU - Aslan, Galip Servet
AU - Spinner, Christoph
AU - Luxán, Guillermo
AU - Hanses, Frank
AU - Dolff, Sebastian
AU - Piepel, Christiane
AU - Ruppert, Clemens
AU - Guenther, Andreas
AU - Rüthrich, Maria Madeleine
AU - Vehreschild, Jörg Janne
AU - Wille, Kai
AU - Haselberger, Martina
AU - Heuzeroth, Hanno
AU - Hansen, Arne
AU - Eschenhagen, Thomas
AU - Cinatl, Jindrich
AU - Ciesek, Sandra
AU - Dimmeler, Stefanie
AU - Borgmann, Stefan
AU - Zeiher, Andreas
AU - LEOSS study group
PY - 2021/10/21
Y1 - 2021/10/21
N2 - AIMS: Patients with cardiovascular comorbidities have a significantly increased risk for a critical course of COVID-19. As the SARS-CoV2 virus enters cells via the angiotensin-converting enzyme receptor II (ACE2), drugs which interact with the renin angiotensin aldosterone system (RAAS) were suspected to influence disease severity.METHODS AND RESULTS: We analyzed 1946 consecutive patients with cardiovascular comorbidities or hypertension enrolled in one of the largest European COVID-19 registries, the Lean European Open Survey on SARS-CoV-2 (LEOSS) registry. Here, we show that angiotensin II receptor blocker intake is associated with decreased mortality in patients with COVID-19 [OR 0.75 (95% CI 0,59-0.96; p = 0.013)]. This effect was mainly driven by patients, who presented in an early phase of COVID-19 at baseline [OR 0,64 (95% CI 0,43-0,96; p = 0.029)]. Kaplan-Meier analysis revealed a significantly lower incidence of death in patients on an angiotensin receptor blocker (ARB) (n = 33/318;10,4%) compared to patients using an angiotensin-converting enzyme inhibitor (ACEi) (n = 60/348;17,2%) or patients who received neither an ACE-inhibitor nor an ARB at baseline in the uncomplicated phase (n = 90/466; 19,3%; p<0.034). Patients taking an ARB were significantly less frequently reaching the mortality predicting threshold for leukocytes (p<0.001), neutrophils (p = 0.002) and the inflammatory markers CRP (p = 0.021), procalcitonin (p = 0.001) and IL-6 (p = 0.049). ACE2 expression levels in human lung samples were not altered in patients taking RAAS modulators.CONCLUSION: These data suggest a beneficial effect of ARBs on disease severity in patients with cardiovascular comorbidities and COVID-19, which is linked to dampened systemic inflammatory activity.
AB - AIMS: Patients with cardiovascular comorbidities have a significantly increased risk for a critical course of COVID-19. As the SARS-CoV2 virus enters cells via the angiotensin-converting enzyme receptor II (ACE2), drugs which interact with the renin angiotensin aldosterone system (RAAS) were suspected to influence disease severity.METHODS AND RESULTS: We analyzed 1946 consecutive patients with cardiovascular comorbidities or hypertension enrolled in one of the largest European COVID-19 registries, the Lean European Open Survey on SARS-CoV-2 (LEOSS) registry. Here, we show that angiotensin II receptor blocker intake is associated with decreased mortality in patients with COVID-19 [OR 0.75 (95% CI 0,59-0.96; p = 0.013)]. This effect was mainly driven by patients, who presented in an early phase of COVID-19 at baseline [OR 0,64 (95% CI 0,43-0,96; p = 0.029)]. Kaplan-Meier analysis revealed a significantly lower incidence of death in patients on an angiotensin receptor blocker (ARB) (n = 33/318;10,4%) compared to patients using an angiotensin-converting enzyme inhibitor (ACEi) (n = 60/348;17,2%) or patients who received neither an ACE-inhibitor nor an ARB at baseline in the uncomplicated phase (n = 90/466; 19,3%; p<0.034). Patients taking an ARB were significantly less frequently reaching the mortality predicting threshold for leukocytes (p<0.001), neutrophils (p = 0.002) and the inflammatory markers CRP (p = 0.021), procalcitonin (p = 0.001) and IL-6 (p = 0.049). ACE2 expression levels in human lung samples were not altered in patients taking RAAS modulators.CONCLUSION: These data suggest a beneficial effect of ARBs on disease severity in patients with cardiovascular comorbidities and COVID-19, which is linked to dampened systemic inflammatory activity.
KW - Adult
KW - Aged
KW - Aged, 80 and over
KW - Angiotensin Receptor Antagonists/administration & dosage
KW - Angiotensin-Converting Enzyme Inhibitors/administration & dosage
KW - Biomarkers/blood
KW - COVID-19/blood
KW - Comorbidity
KW - Disease-Free Survival
KW - Female
KW - Humans
KW - Hypertension/blood
KW - Inflammation/blood
KW - Male
KW - Middle Aged
KW - Registries
KW - SARS-CoV-2/metabolism
KW - Severity of Illness Index
KW - Survival Rate
U2 - 10.1371/journal.pone.0258684
DO - 10.1371/journal.pone.0258684
M3 - SCORING: Journal article
C2 - 34673795
VL - 16
JO - PLOS ONE
JF - PLOS ONE
SN - 1932-6203
IS - 10
M1 - e0258684
ER -