The study mentioned in this article has been retracted, please read with additional care. For more information, please click here.
The ongoing COVID-19 pandemic not only posed challenges and uncertainties to our healthcare systems but also ignited many questions. One of which is whether individuals with pre-existing medical conditions are at a higher probability of catching the virus and if comorbidity also contributes to the severity of their illnesses.
Medications in question
Specifically, some animal studies suggested certain medications may increase a body’s level of ACE2, a protein that will bind with Severe Acute Respiratory Syndrome Coronavirus (SARS-CoV-2), the causative agent of COVID-19 when it invades human cells, making users to be more susceptible to the disease. On the other hand, conflicting animal study results indicated a higher level of ACE2 may actually reduce inflammatory reaction in the lungs, a benefitting effect for those who are suffering from COVID-19.
The medications of concerns are Angiotensin-converting-enzyme (ACE) inhibitors and angiotensin-receptor blockers (ARBs). Both of which are commonly prescribed to control one’s blood pressure. The former includes generic drugs ending in -pril like lisinopril and Captopril while the latter are those ending in -sartan such as Iosartan and Valsartan. However, there is insufficient evidence to confirm whether human will also show similar reactions.
Medical colleges and councils urged patients to remain calm and continue using their medications because high blood pressure is one of the risk factors for heart diseases, strokes and kidney damage. As fear lingers, researchers embarked on investigations looking at the relationships between drug therapy, cardiovascular disease and outcomes of COVID-19.
ACE inhibitors and statins don’t increase risks for COVID-19
One of the research teams making of experts from Brigham and Women’s Hospital, Harvard Medical School, University of Utah and so on analyzed de-identified data obtained from an international registry – Surgical Outcomes Collaborative (Surgisphere).
Information from more than 8000 COVID-19 positive patients admitted to 169 hospitals located in 11 countries across Asia, Europe and North America admitted to medical facilities between 20 December 2019 and 15 March 2020 were systematically studied. Researchers found that indeed, pre-existing cardiovascular disease is associated with an increased risk of in-hospital death among patients who were hospitalized because of COVID-19.
However, no potential harmful connections were found between ACE inhibitors or ARBs with in-hospital death. The findings were published in The New England Journal of Medicine (NEJM)on 1 May. Two separate studies done by researchers from New York University Grossman School of Medicine and China on two other populations also yielded similar results.
The consistency reassures the public that ACE inhibitors and statins do not increase one’s risks for coronavirus and patients should carry on with their respective medications as advised.
Significance of the studies
Nevertheless, all three studies are “observational”, this means researchers only examine the effect of a risk factor and no cause and effect should be deduced. In general, “observational” study should be regarded differently from “experimental” study whereby interventions and control were introduced into an investigation to ensure results do not happen by chance.
In fact, Dr. Sapan S. Desai, President and Chief Executive Officer (CEO) of Surgisphere and one of the principal investigators for the NEJM study also warned that the research team only looked at ACE inhibitors and statins from the perspective of the drug being a part of one’s medication history. They did not explore whether intentionally using these medications as a way of somehow stopping the virus would be effective. Hence, even though previous animal studies found to reduce inflammatory reaction in the lungs, patients should not use ACE inhibitors and statins in circumstances that they are not prescribed for.
“Patients should always follow the advice of a qualified and competent healthcare professional. Starting or stopping a medication, particularly if it is not indicated, could be very dangerous” Dr. Desai told AIMed.
Despite so, Dr. Desai believes the study is significant in several ways. First of all, it “uses a large, real-time global registry to identify cardiovascular disease is strongly associated with poor outcomes in COVID-19 patients”. Next, it “demonstrates that blood pressure medication that work along the ACE1 pathway are not associated with greater mortality” and last but not least, medications “associated with survival should be interpreted with caution”.