The Effects of ARBs, ACEis, and Statins on Clinical Outcomes of COVID-19 Infection Among Nursing Home Residents

Anton De Spiegeleer; Antoon Bronselaer; James T. Teo; Geert Byttebier; Guy De Tré; Luc Belmans; Richard Dobson; Evelien Wynendaele; Christophe Van De Wiele; Filip Vandaele; Diemer Van Dijck; Dan Bean; David Fedson; Bart De Spiegeleer

doi:10.1016/j.jamda.2020.06.018

The Effects of ARBs, ACEis, and Statins on Clinical Outcomes of COVID-19 Infection Among Nursing Home Residents

Anton De Spiegeleer, Antoon Bronselaer, James T. Teo, Geert Byttebier, Guy De Tré, Luc Belmans, Richard Dobson, Evelien Wynendaele, Christophe Van De Wiele, Filip Vandaele, Diemer Van Dijck, Dan Bean, David Fedson, Bart De Spiegeleer^*

^*Corresponding author for this work

Research output: Contribution to journal › Article › peer-review

127 Citations (Scopus)

Abstract

Objectives: Angiotensin-converting enzyme inhibitors (ACEi), angiotensin II receptor blockers (ARBs), and HMG-CoA reductase inhibitors (“statins”) have been hypothesized to affect COVID-19 severity. However, up to now, no studies investigating this association have been conducted in the most vulnerable and affected population groups (ie, older adults residing in nursing homes). The objective of this study was to explore the association of ACEi/ARB and/or statins with clinical manifestations in COVID-19–infected older adults residing in nursing homes. Design: We undertook a retrospective multicenter cohort study to analyze the association between ACEi/ARB and/or statin use with clinical outcome of COVID-19. The outcomes were (1) serious COVID-19 defined as long-stay hospital admission or death within 14 days of disease onset, and (2) asymptomatic (ie, no disease symptoms in the whole study period while still being diagnosed by polymerase chain reaction). Setting and participants: A total of 154 COVID-19–positive subjects were identified, residing in 1 of 2 Belgian nursing homes that experienced similar COVID-19 outbreaks. Measures: Logistic regression models were applied with age, sex, functional status, diabetes, and hypertension as covariates. Results: We found a statistically significant association between statin intake and the absence of symptoms during COVID-19 (odds ratio [OR] 2.91; confidence interval [CI] 1.27–6.71), which remained statistically significant after adjusting for covariates (OR 2.65; CI 1.13–6.68). Although the effects of statin intake on serious clinical outcome were in the same beneficial direction, these were not statistically significant (OR 0.75; CI 0.24–1.87). There was also no statistically significant association between ACEi/ARB and asymptomatic status (OR 2.72; CI 0.59–25.1) or serious clinical outcome (OR 0.48; CI 0.10–1.97). Conclusions and Implications: Our data indicate that statin intake in older, frail adults could be associated with a considerable beneficial effect on COVID-19 clinical symptoms. The role of statins and renin-angiotensin system drugs needs to be further explored in larger observational studies as well as randomized clinical trials.

Original language	English
Pages (from-to)	909-914.e2
Journal	Journal Of The American Medical Directors Association
Volume	21
Issue number	7
DOIs	https://doi.org/10.1016/j.jamda.2020.06.018
Publication status	Published - Jul 2020

Keywords

angiotensin II receptor blockers
Angiotensin-converting enzyme inhibitors
COVID-19
nursing home residents
statins

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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10.1016/j.jamda.2020.06.018

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De Spiegeleer, A., Bronselaer, A., Teo, J. T., Byttebier, G., De Tré, G., Belmans, L., Dobson, R., Wynendaele, E., Van De Wiele, C., Vandaele, F., Van Dijck, D., Bean, D., Fedson, D., & De Spiegeleer, B. (2020). The Effects of ARBs, ACEis, and Statins on Clinical Outcomes of COVID-19 Infection Among Nursing Home Residents. Journal Of The American Medical Directors Association, 21(7), 909-914.e2. https://doi.org/10.1016/j.jamda.2020.06.018

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title = "The Effects of ARBs, ACEis, and Statins on Clinical Outcomes of COVID-19 Infection Among Nursing Home Residents",

abstract = "Objectives: Angiotensin-converting enzyme inhibitors (ACEi), angiotensin II receptor blockers (ARBs), and HMG-CoA reductase inhibitors (“statins”) have been hypothesized to affect COVID-19 severity. However, up to now, no studies investigating this association have been conducted in the most vulnerable and affected population groups (ie, older adults residing in nursing homes). The objective of this study was to explore the association of ACEi/ARB and/or statins with clinical manifestations in COVID-19–infected older adults residing in nursing homes. Design: We undertook a retrospective multicenter cohort study to analyze the association between ACEi/ARB and/or statin use with clinical outcome of COVID-19. The outcomes were (1) serious COVID-19 defined as long-stay hospital admission or death within 14 days of disease onset, and (2) asymptomatic (ie, no disease symptoms in the whole study period while still being diagnosed by polymerase chain reaction). Setting and participants: A total of 154 COVID-19–positive subjects were identified, residing in 1 of 2 Belgian nursing homes that experienced similar COVID-19 outbreaks. Measures: Logistic regression models were applied with age, sex, functional status, diabetes, and hypertension as covariates. Results: We found a statistically significant association between statin intake and the absence of symptoms during COVID-19 (odds ratio [OR] 2.91; confidence interval [CI] 1.27–6.71), which remained statistically significant after adjusting for covariates (OR 2.65; CI 1.13–6.68). Although the effects of statin intake on serious clinical outcome were in the same beneficial direction, these were not statistically significant (OR 0.75; CI 0.24–1.87). There was also no statistically significant association between ACEi/ARB and asymptomatic status (OR 2.72; CI 0.59–25.1) or serious clinical outcome (OR 0.48; CI 0.10–1.97). Conclusions and Implications: Our data indicate that statin intake in older, frail adults could be associated with a considerable beneficial effect on COVID-19 clinical symptoms. The role of statins and renin-angiotensin system drugs needs to be further explored in larger observational studies as well as randomized clinical trials.",

keywords = "angiotensin II receptor blockers, Angiotensin-converting enzyme inhibitors, COVID-19, nursing home residents, statins",

author = "{De Spiegeleer}, Anton and Antoon Bronselaer and Teo, {James T.} and Geert Byttebier and {De Tr{\'e}}, Guy and Luc Belmans and Richard Dobson and Evelien Wynendaele and {Van De Wiele}, Christophe and Filip Vandaele and {Van Dijck}, Diemer and Dan Bean and David Fedson and {De Spiegeleer}, Bart",

year = "2020",

month = jul,

doi = "10.1016/j.jamda.2020.06.018",

language = "English",

volume = "21",

pages = "909--914.e2",

journal = "Journal Of The American Medical Directors Association",

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De Spiegeleer, A, Bronselaer, A, Teo, JT, Byttebier, G, De Tré, G, Belmans, L, Dobson, R, Wynendaele, E, Van De Wiele, C, Vandaele, F, Van Dijck, D, Bean, D, Fedson, D & De Spiegeleer, B 2020, 'The Effects of ARBs, ACEis, and Statins on Clinical Outcomes of COVID-19 Infection Among Nursing Home Residents', Journal Of The American Medical Directors Association, vol. 21, no. 7, pp. 909-914.e2. https://doi.org/10.1016/j.jamda.2020.06.018

TY - JOUR

T1 - The Effects of ARBs, ACEis, and Statins on Clinical Outcomes of COVID-19 Infection Among Nursing Home Residents

AU - De Spiegeleer, Anton

AU - Bronselaer, Antoon

AU - Teo, James T.

AU - Byttebier, Geert

AU - De Tré, Guy

AU - Belmans, Luc

AU - Dobson, Richard

AU - Wynendaele, Evelien

AU - Van De Wiele, Christophe

AU - Vandaele, Filip

AU - Van Dijck, Diemer

AU - Bean, Dan

AU - Fedson, David

AU - De Spiegeleer, Bart

PY - 2020/7

Y1 - 2020/7

N2 - Objectives: Angiotensin-converting enzyme inhibitors (ACEi), angiotensin II receptor blockers (ARBs), and HMG-CoA reductase inhibitors (“statins”) have been hypothesized to affect COVID-19 severity. However, up to now, no studies investigating this association have been conducted in the most vulnerable and affected population groups (ie, older adults residing in nursing homes). The objective of this study was to explore the association of ACEi/ARB and/or statins with clinical manifestations in COVID-19–infected older adults residing in nursing homes. Design: We undertook a retrospective multicenter cohort study to analyze the association between ACEi/ARB and/or statin use with clinical outcome of COVID-19. The outcomes were (1) serious COVID-19 defined as long-stay hospital admission or death within 14 days of disease onset, and (2) asymptomatic (ie, no disease symptoms in the whole study period while still being diagnosed by polymerase chain reaction). Setting and participants: A total of 154 COVID-19–positive subjects were identified, residing in 1 of 2 Belgian nursing homes that experienced similar COVID-19 outbreaks. Measures: Logistic regression models were applied with age, sex, functional status, diabetes, and hypertension as covariates. Results: We found a statistically significant association between statin intake and the absence of symptoms during COVID-19 (odds ratio [OR] 2.91; confidence interval [CI] 1.27–6.71), which remained statistically significant after adjusting for covariates (OR 2.65; CI 1.13–6.68). Although the effects of statin intake on serious clinical outcome were in the same beneficial direction, these were not statistically significant (OR 0.75; CI 0.24–1.87). There was also no statistically significant association between ACEi/ARB and asymptomatic status (OR 2.72; CI 0.59–25.1) or serious clinical outcome (OR 0.48; CI 0.10–1.97). Conclusions and Implications: Our data indicate that statin intake in older, frail adults could be associated with a considerable beneficial effect on COVID-19 clinical symptoms. The role of statins and renin-angiotensin system drugs needs to be further explored in larger observational studies as well as randomized clinical trials.

AB - Objectives: Angiotensin-converting enzyme inhibitors (ACEi), angiotensin II receptor blockers (ARBs), and HMG-CoA reductase inhibitors (“statins”) have been hypothesized to affect COVID-19 severity. However, up to now, no studies investigating this association have been conducted in the most vulnerable and affected population groups (ie, older adults residing in nursing homes). The objective of this study was to explore the association of ACEi/ARB and/or statins with clinical manifestations in COVID-19–infected older adults residing in nursing homes. Design: We undertook a retrospective multicenter cohort study to analyze the association between ACEi/ARB and/or statin use with clinical outcome of COVID-19. The outcomes were (1) serious COVID-19 defined as long-stay hospital admission or death within 14 days of disease onset, and (2) asymptomatic (ie, no disease symptoms in the whole study period while still being diagnosed by polymerase chain reaction). Setting and participants: A total of 154 COVID-19–positive subjects were identified, residing in 1 of 2 Belgian nursing homes that experienced similar COVID-19 outbreaks. Measures: Logistic regression models were applied with age, sex, functional status, diabetes, and hypertension as covariates. Results: We found a statistically significant association between statin intake and the absence of symptoms during COVID-19 (odds ratio [OR] 2.91; confidence interval [CI] 1.27–6.71), which remained statistically significant after adjusting for covariates (OR 2.65; CI 1.13–6.68). Although the effects of statin intake on serious clinical outcome were in the same beneficial direction, these were not statistically significant (OR 0.75; CI 0.24–1.87). There was also no statistically significant association between ACEi/ARB and asymptomatic status (OR 2.72; CI 0.59–25.1) or serious clinical outcome (OR 0.48; CI 0.10–1.97). Conclusions and Implications: Our data indicate that statin intake in older, frail adults could be associated with a considerable beneficial effect on COVID-19 clinical symptoms. The role of statins and renin-angiotensin system drugs needs to be further explored in larger observational studies as well as randomized clinical trials.

KW - angiotensin II receptor blockers

KW - Angiotensin-converting enzyme inhibitors

KW - COVID-19

KW - nursing home residents

KW - statins

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U2 - 10.1016/j.jamda.2020.06.018

DO - 10.1016/j.jamda.2020.06.018

M3 - Article

C2 - 32674818

AN - SCOPUS:85087026873

SN - 1525-8610

VL - 21

SP - 909-914.e2

JO - Journal Of The American Medical Directors Association

JF - Journal Of The American Medical Directors Association

IS - 7

ER -

The Effects of ARBs, ACEis, and Statins on Clinical Outcomes of COVID-19 Infection Among Nursing Home Residents

Abstract

Keywords

UN SDGs

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