TY  - JOUR
A1  - Cremer, Sebastian
A1  - Pilgram, Lisa
A1  - Berkowitsch, Alexander
A1  - Stecher, Melanie
A1  - Rieg, Siegbert
A1  - Shumliakivska, Mariana
A1  - Bojkova, Denisa
A1  - Wagner, Julian Uwe Gabriel
A1  - Aslan, Galip Servet
A1  - Spinner, Christoph Daniel
A1  - Luxán, Guillermo
A1  - Hanses, Frank
A1  - Dolff, Sebastian Conrad Johannes
A1  - Piepel, Christiane
A1  - Ruppert, Clemens
A1  - Günther, Andreas
A1  - Rüthrich, Maria Madeleine
A1  - Vehreschild, Jörg Janne
A1  - Wille, Kai
A1  - Haselberger, Martina Maria
A1  - Heuzeroth, Hanno
A1  - Hansen, Arne
A1  - Eschenhagen, Thomas
A1  - Cinatl, Jindrich
A1  - Ciesek, Sandra
A1  - Dimmeler, Stefanie
A1  - Borgmann, Stefan
A1  - Zeiher, Andreas M.
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
T2  - PLOS ONE
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.
KW  - COVID 19
KW  - Biomarkers
KW  - Inflammation
KW  - Hypertension
KW  - Cardiovascular disease risk
KW  - SARS CoV 2
KW  - Cardiovascular diseases
KW  - Multivariate analysis
Y1  - 2021
UR  - http://publikationen.ub.uni-frankfurt.de/frontdoor/index/index/docId/62711
UR  - https://nbn-resolving.org/urn:nbn:de:hebis:30:3-627113
SN  - 1932-6203
VL  - 16
IS  - 10, art. e0258684
SP  - 1
EP  - 17
PB  - PLOS
CY  - San Francisco, California, US
ER  -