近日，美国布列根和妇女医院Mandeep R. Mehra团队探讨了Covid-19中的心血管疾病、药物治疗和死亡率。该成果发表在2020年5月1日出版的《新英格兰医学杂志》上。

冠状病毒病2019（Covid-19）可能会严重影响患有心血管疾病的人。在这种临床背景下，血管紧张素转换酶（ACE）抑制剂和血管紧张素受体阻滞剂（ARB）的潜在有害作用引起了人们的关注。

研究组使用来自亚洲、欧洲和北美的169家医院的观察性数据库，评估了2019年12月20日至3月15日Covid-19住院患者的心血管疾病和药物治疗与院内死亡的相关性。

在出院状况数据可用的8910名Covid-19患者中，515名在医院内死亡（5.8%），8395名幸存者出院。研究组发现与院内死亡风险增加独立相关的危险因素是年龄大于65岁、冠状动脉疾病、心力衰竭、心律不齐、慢性阻塞性肺疾病和当前吸烟。使用ACE抑制剂或ARBs与院内死亡风险增加均不相关。

总之，在Covid-19住院的患者中，潜在心血管疾病与院内死亡风险增加相关，使用ACE抑制剂或ARB与院内死亡风险不相关。

附：英文原文

Title: Cardiovascular Disease, Drug Therapy, and Mortality in Covid-19

Author: Mandeep R. Mehra, M.D.,, Sapan S. Desai, M.D., Ph.D.,, SreyRam Kuy, M.D., M.H.S.,, Timothy D. Henry, M.D.,, and Amit N. Patel, M.D.

Issue&Volume: 2020-05-01

Abstract: BACKGROUND

Coronavirus disease 2019 (Covid-19) may disproportionately affect people with cardiovascular disease. Concern has been aroused regarding a potential harmful effect of angiotensin-converting–enzyme (ACE) inhibitors and angiotensin-receptor blockers (ARBs) in this clinical context.

METHODS

Using an observational database from 169 hospitals in Asia, Europe, and North America, we evaluated the relationship of cardiovascular disease and drug therapy with in-hospital death among hospitalized patients with Covid-19 who were admitted between December 20, 2019, and March 15, 2020, and were recorded in the Surgical Outcomes Collaborative registry as having either died in the hospital or survived to discharge as of March 28, 2020.

RESULTS

Of the 8910 patients with Covid-19 for whom discharge status was available at the time of the analysis, a total of 515 died in the hospital (5.8%) and 8395 survived to discharge. The factors we found to be independently associated with an increased risk of in-hospital death were an age greater than 65 years (mortality of 10.0%, vs. 4.9% among those ≤65 years of age; odds ratio, 1.93; 95% confidence interval [CI], 1.60 to 2.41), coronary artery disease (10.2%, vs. 5.2% among those without disease; odds ratio, 2.70; 95% CI, 2.08 to 3.51), heart failure (15.3%, vs. 5.6% among those without heart failure; odds ratio, 2.48; 95% CI, 1.62 to 3.79), cardiac arrhythmia (11.5%, vs. 5.6% among those without arrhythmia; odds ratio, 1.95; 95% CI, 1.33 to 2.86), chronic obstructive pulmonary disease (14.2%, vs. 5.6% among those without disease; odds ratio, 2.96; 95% CI, 2.00 to 4.40), and current smoking (9.4%, vs. 5.6% among former smokers or nonsmokers; odds ratio, 1.79; 95% CI, 1.29 to 2.47). No increased risk of in-hospital death was found to be associated with the use of ACE inhibitors (2.1% vs. 6.1%; odds ratio, 0.33; 95% CI, 0.20 to 0.54) or the use of ARBs (6.8% vs. 5.7%; odds ratio, 1.23; 95% CI, 0.87 to 1.74).

CONCLUSIONS

Our study confirmed previous observations suggesting that underlying cardiovascular disease is associated with an increased risk of in-hospital death among patients hospitalized with Covid-19. Our results did not confirm previous concerns regarding a potential harmful association of ACE inhibitors or ARBs with in-hospital death in this clinical context.

DOI: NJ202005013822502

Source: https://www.nejm.org/doi/full/10.1056/NEJMoa2007621