In-hospital use of ACE inhibitors/angiotensin receptor blockers associates with COVID-19 outcomes in African American patients
BACKGROUNDThe angiotensin-converting enzyme (ACE) D allele is more prevalent among African Americans compared with other races and ethnicities and has previously been associated with severe coronavirus disease 2019 (COVID-19) pathogenesis through excessive ACE1 activity. ACE inhibitors/angiotensin r...
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| Veröffentlicht in: | The Journal of clinical investigation 2021-10, Vol.131 (19) |
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| creator | Li, Shilong Sarangarajan, Rangaprasad Jun, Tomi Kao, Yu-Han Wang, Zichen Hao, Ke Schadt, Emilio Kiebish, Michael A Granger, Elder Narain, Niven R Chen, Rong Schadt, Eric E Li, Li |
| description | BACKGROUNDThe angiotensin-converting enzyme (ACE) D allele is more prevalent among African Americans compared with other races and ethnicities and has previously been associated with severe coronavirus disease 2019 (COVID-19) pathogenesis through excessive ACE1 activity. ACE inhibitors/angiotensin receptor blockers (ACE-I/ARB) may counteract this mechanism, but their association with COVID-19 outcomes has not been specifically tested in the African American population.METHODSWe identified 6218 patients who were admitted into Mount Sinai hospitals with COVID-19 between February 24 and May 31, 2020, in New York City. We evaluated whether the outpatient and in-hospital use of ACE-I/ARB is associated with COVID-19 in-hospital mortality in an African American compared with non-African American population.RESULTSOf the 6218 patients with COVID-19, 1138 (18.3%) were ACE-I/ARB users. In a multivariate logistic regression model, ACE-I/ARB use was independently associated with a reduced risk of in-hospital mortality in the entire population (OR, 0.655; 95% CI, 0.505-0.850; P = 0.001), African American population (OR, 0.44; 95% CI, 0.249-0.779; P = 0.005), and non-African American population (OR, 0.748, 95% CI, 0.553-1.012, P = 0.06). In the African American population, in-hospital use of ACE-I/ARB was associated with improved mortality (OR, 0.378; 95% CI, 0.188-0.766; P = 0.006), whereas outpatient use was not (OR, 0.889; 95% CI, 0.375-2.158; P = 0.812). When analyzing each medication class separately, ARB in-hospital use was significantly associated with reduced in-hospital mortality in the African American population (OR, 0.196; 95% CI, 0.074-0.516; P = 0.001), whereas ACE-I use was not associated with impact on mortality in any population.CONCLUSIONIn-hospital use of ARB was associated with a significant reduction in in-hospital mortality among COVID-19-positive African American patients.FUNDINGNone. |
| doi_str_mv | 10.1172/JCI151418 |
| format | Article |
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ACE inhibitors/angiotensin receptor blockers (ACE-I/ARB) may counteract this mechanism, but their association with COVID-19 outcomes has not been specifically tested in the African American population.METHODSWe identified 6218 patients who were admitted into Mount Sinai hospitals with COVID-19 between February 24 and May 31, 2020, in New York City. We evaluated whether the outpatient and in-hospital use of ACE-I/ARB is associated with COVID-19 in-hospital mortality in an African American compared with non-African American population.RESULTSOf the 6218 patients with COVID-19, 1138 (18.3%) were ACE-I/ARB users. In a multivariate logistic regression model, ACE-I/ARB use was independently associated with a reduced risk of in-hospital mortality in the entire population (OR, 0.655; 95% CI, 0.505-0.850; P = 0.001), African American population (OR, 0.44; 95% CI, 0.249-0.779; P = 0.005), and non-African American population (OR, 0.748, 95% CI, 0.553-1.012, P = 0.06). In the African American population, in-hospital use of ACE-I/ARB was associated with improved mortality (OR, 0.378; 95% CI, 0.188-0.766; P = 0.006), whereas outpatient use was not (OR, 0.889; 95% CI, 0.375-2.158; P = 0.812). When analyzing each medication class separately, ARB in-hospital use was significantly associated with reduced in-hospital mortality in the African American population (OR, 0.196; 95% CI, 0.074-0.516; P = 0.001), whereas ACE-I use was not associated with impact on mortality in any population.CONCLUSIONIn-hospital use of ARB was associated with a significant reduction in in-hospital mortality among COVID-19-positive African American patients.FUNDINGNone.</description><identifier>ISSN: 1558-8238</identifier><identifier>ISSN: 0021-9738</identifier><identifier>EISSN: 1558-8238</identifier><identifier>DOI: 10.1172/JCI151418</identifier><identifier>PMID: 34411004</identifier><language>eng</language><publisher>United States: American Society for Clinical Investigation</publisher><subject>ACE inhibitors ; African Americans ; Aged ; Angiotensin Receptor Antagonists - administration & dosage ; Angiotensin-Converting Enzyme Inhibitors - administration & dosage ; Clinical Medicine ; COVID-19 - drug therapy ; COVID-19 - ethnology ; COVID-19 - metabolism ; COVID-19 - mortality ; Disease-Free Survival ; Drug therapy ; Female ; Hospital Mortality - ethnology ; Hospital patients ; Humans ; Male ; Middle Aged ; Peptidyl-Dipeptidase A - metabolism ; Retrospective Studies ; SARS-CoV-2 - metabolism ; Survival Rate</subject><ispartof>The Journal of clinical investigation, 2021-10, Vol.131 (19)</ispartof><rights>COPYRIGHT 2021 American Society for Clinical Investigation</rights><rights>2021 American Society for Clinical Investigation 2021 American Society for Clinical Investigation</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c579t-183af70344703b223065708e1417132acc15bce23fb469c6dcb04fa8953f48ff3</citedby><cites>FETCH-LOGICAL-c579t-183af70344703b223065708e1417132acc15bce23fb469c6dcb04fa8953f48ff3</cites><orcidid>0000-0003-2416-4395 ; 0000-0002-9581-8029 ; 0000-0002-2120-1704 ; 0000-0001-7683-6566 ; 0000-0002-1415-1286 ; 0000-0002-1815-9197 ; 0000-0001-6746-4297 ; 0000-0001-6769-1748</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC8483748/pdf/$$EPDF$$P50$$Gpubmedcentral$$H</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC8483748/$$EHTML$$P50$$Gpubmedcentral$$H</linktohtml><link.rule.ids>230,314,723,776,780,881,27901,27902,53766,53768</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/34411004$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Li, Shilong</creatorcontrib><creatorcontrib>Sarangarajan, Rangaprasad</creatorcontrib><creatorcontrib>Jun, Tomi</creatorcontrib><creatorcontrib>Kao, Yu-Han</creatorcontrib><creatorcontrib>Wang, Zichen</creatorcontrib><creatorcontrib>Hao, Ke</creatorcontrib><creatorcontrib>Schadt, Emilio</creatorcontrib><creatorcontrib>Kiebish, Michael A</creatorcontrib><creatorcontrib>Granger, Elder</creatorcontrib><creatorcontrib>Narain, Niven R</creatorcontrib><creatorcontrib>Chen, Rong</creatorcontrib><creatorcontrib>Schadt, Eric E</creatorcontrib><creatorcontrib>Li, Li</creatorcontrib><title>In-hospital use of ACE inhibitors/angiotensin receptor blockers associates with COVID-19 outcomes in African American patients</title><title>The Journal of clinical investigation</title><addtitle>J Clin Invest</addtitle><description>BACKGROUNDThe angiotensin-converting enzyme (ACE) D allele is more prevalent among African Americans compared with other races and ethnicities and has previously been associated with severe coronavirus disease 2019 (COVID-19) pathogenesis through excessive ACE1 activity. ACE inhibitors/angiotensin receptor blockers (ACE-I/ARB) may counteract this mechanism, but their association with COVID-19 outcomes has not been specifically tested in the African American population.METHODSWe identified 6218 patients who were admitted into Mount Sinai hospitals with COVID-19 between February 24 and May 31, 2020, in New York City. We evaluated whether the outpatient and in-hospital use of ACE-I/ARB is associated with COVID-19 in-hospital mortality in an African American compared with non-African American population.RESULTSOf the 6218 patients with COVID-19, 1138 (18.3%) were ACE-I/ARB users. In a multivariate logistic regression model, ACE-I/ARB use was independently associated with a reduced risk of in-hospital mortality in the entire population (OR, 0.655; 95% CI, 0.505-0.850; P = 0.001), African American population (OR, 0.44; 95% CI, 0.249-0.779; P = 0.005), and non-African American population (OR, 0.748, 95% CI, 0.553-1.012, P = 0.06). In the African American population, in-hospital use of ACE-I/ARB was associated with improved mortality (OR, 0.378; 95% CI, 0.188-0.766; P = 0.006), whereas outpatient use was not (OR, 0.889; 95% CI, 0.375-2.158; P = 0.812). When analyzing each medication class separately, ARB in-hospital use was significantly associated with reduced in-hospital mortality in the African American population (OR, 0.196; 95% CI, 0.074-0.516; P = 0.001), whereas ACE-I use was not associated with impact on mortality in any population.CONCLUSIONIn-hospital use of ARB was associated with a significant reduction in in-hospital mortality among COVID-19-positive African American patients.FUNDINGNone.</description><subject>ACE inhibitors</subject><subject>African Americans</subject><subject>Aged</subject><subject>Angiotensin Receptor Antagonists - administration & dosage</subject><subject>Angiotensin-Converting Enzyme Inhibitors - administration & dosage</subject><subject>Clinical Medicine</subject><subject>COVID-19 - drug therapy</subject><subject>COVID-19 - ethnology</subject><subject>COVID-19 - metabolism</subject><subject>COVID-19 - mortality</subject><subject>Disease-Free Survival</subject><subject>Drug therapy</subject><subject>Female</subject><subject>Hospital Mortality - ethnology</subject><subject>Hospital patients</subject><subject>Humans</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Peptidyl-Dipeptidase A - metabolism</subject><subject>Retrospective Studies</subject><subject>SARS-CoV-2 - metabolism</subject><subject>Survival Rate</subject><issn>1558-8238</issn><issn>0021-9738</issn><issn>1558-8238</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2021</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqNkt-L1DAQx4so3rn64D8gBUH0oXdJk27TF2Gpp1YOFvxxryHNTrbRNqmd1B8v_u3m2HPZhX2QkMww-cx38mOS5CklF5SW-eWHuqEF5VTcS85pUYhM5EzcP_DPkkeIXwmhnBf8YXLGOKeUEH6e_Glc1nkcbVB9OiOk3qSr-iq1rrOtDX7CS-W21gdwaF06gYYxRtO29_obTJgqRK-tCoDpTxu6tF7fNG8yWqV-DtoPMRzTVmayWkU7wM4ZVbDgAj5OHhjVIzy5s4vky9urz_X77Hr9rqlX15kuyipkVDBlShKPHZc2zxlZFiUREO9cUpYrrWnRasiZafmy0suNbgk3SlQFM1wYwxbJ653uOLcDbHSsPalejpMd1PRbemXl8Y6zndz6H1Jwwco4F8nLO4HJf58Bgxwsauh75cDPKPNiyXiei4pE9PkO3aoepHXGR0V9i8vVshRVWQlaRCo7QW3BQSzvHRgbw0f8xQk-jg0MVp9MeHWUEJkAv8JWzYiy-fTx_9n1zTH74oDtQPWhQ9_PwXqHJ0X15BEnMPvnpkTe9q3c921knx3-z57816jsL_JH5Q4</recordid><startdate>20211001</startdate><enddate>20211001</enddate><creator>Li, Shilong</creator><creator>Sarangarajan, Rangaprasad</creator><creator>Jun, Tomi</creator><creator>Kao, Yu-Han</creator><creator>Wang, Zichen</creator><creator>Hao, Ke</creator><creator>Schadt, Emilio</creator><creator>Kiebish, Michael A</creator><creator>Granger, Elder</creator><creator>Narain, Niven R</creator><creator>Chen, Rong</creator><creator>Schadt, Eric E</creator><creator>Li, Li</creator><general>American Society for Clinical Investigation</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>IOV</scope><scope>ISR</scope><scope>7X8</scope><scope>5PM</scope><orcidid>https://orcid.org/0000-0003-2416-4395</orcidid><orcidid>https://orcid.org/0000-0002-9581-8029</orcidid><orcidid>https://orcid.org/0000-0002-2120-1704</orcidid><orcidid>https://orcid.org/0000-0001-7683-6566</orcidid><orcidid>https://orcid.org/0000-0002-1415-1286</orcidid><orcidid>https://orcid.org/0000-0002-1815-9197</orcidid><orcidid>https://orcid.org/0000-0001-6746-4297</orcidid><orcidid>https://orcid.org/0000-0001-6769-1748</orcidid></search><sort><creationdate>20211001</creationdate><title>In-hospital use of ACE inhibitors/angiotensin receptor blockers associates with COVID-19 outcomes in African American patients</title><author>Li, Shilong ; Sarangarajan, Rangaprasad ; Jun, Tomi ; Kao, Yu-Han ; Wang, Zichen ; Hao, Ke ; Schadt, Emilio ; Kiebish, Michael A ; Granger, Elder ; Narain, Niven R ; Chen, Rong ; Schadt, Eric E ; Li, Li</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c579t-183af70344703b223065708e1417132acc15bce23fb469c6dcb04fa8953f48ff3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2021</creationdate><topic>ACE inhibitors</topic><topic>African Americans</topic><topic>Aged</topic><topic>Angiotensin Receptor Antagonists - administration & dosage</topic><topic>Angiotensin-Converting Enzyme Inhibitors - administration & dosage</topic><topic>Clinical Medicine</topic><topic>COVID-19 - drug therapy</topic><topic>COVID-19 - ethnology</topic><topic>COVID-19 - metabolism</topic><topic>COVID-19 - mortality</topic><topic>Disease-Free Survival</topic><topic>Drug therapy</topic><topic>Female</topic><topic>Hospital Mortality - ethnology</topic><topic>Hospital patients</topic><topic>Humans</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Peptidyl-Dipeptidase A - metabolism</topic><topic>Retrospective Studies</topic><topic>SARS-CoV-2 - metabolism</topic><topic>Survival Rate</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Li, Shilong</creatorcontrib><creatorcontrib>Sarangarajan, Rangaprasad</creatorcontrib><creatorcontrib>Jun, Tomi</creatorcontrib><creatorcontrib>Kao, Yu-Han</creatorcontrib><creatorcontrib>Wang, Zichen</creatorcontrib><creatorcontrib>Hao, Ke</creatorcontrib><creatorcontrib>Schadt, Emilio</creatorcontrib><creatorcontrib>Kiebish, Michael A</creatorcontrib><creatorcontrib>Granger, Elder</creatorcontrib><creatorcontrib>Narain, Niven R</creatorcontrib><creatorcontrib>Chen, Rong</creatorcontrib><creatorcontrib>Schadt, Eric E</creatorcontrib><creatorcontrib>Li, Li</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Gale In Context: Opposing Viewpoints</collection><collection>Gale In Context: Science</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>The Journal of clinical investigation</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Li, Shilong</au><au>Sarangarajan, Rangaprasad</au><au>Jun, Tomi</au><au>Kao, Yu-Han</au><au>Wang, Zichen</au><au>Hao, Ke</au><au>Schadt, Emilio</au><au>Kiebish, Michael A</au><au>Granger, Elder</au><au>Narain, Niven R</au><au>Chen, Rong</au><au>Schadt, Eric E</au><au>Li, Li</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>In-hospital use of ACE inhibitors/angiotensin receptor blockers associates with COVID-19 outcomes in African American patients</atitle><jtitle>The Journal of clinical investigation</jtitle><addtitle>J Clin Invest</addtitle><date>2021-10-01</date><risdate>2021</risdate><volume>131</volume><issue>19</issue><issn>1558-8238</issn><issn>0021-9738</issn><eissn>1558-8238</eissn><abstract>BACKGROUNDThe angiotensin-converting enzyme (ACE) D allele is more prevalent among African Americans compared with other races and ethnicities and has previously been associated with severe coronavirus disease 2019 (COVID-19) pathogenesis through excessive ACE1 activity. ACE inhibitors/angiotensin receptor blockers (ACE-I/ARB) may counteract this mechanism, but their association with COVID-19 outcomes has not been specifically tested in the African American population.METHODSWe identified 6218 patients who were admitted into Mount Sinai hospitals with COVID-19 between February 24 and May 31, 2020, in New York City. We evaluated whether the outpatient and in-hospital use of ACE-I/ARB is associated with COVID-19 in-hospital mortality in an African American compared with non-African American population.RESULTSOf the 6218 patients with COVID-19, 1138 (18.3%) were ACE-I/ARB users. In a multivariate logistic regression model, ACE-I/ARB use was independently associated with a reduced risk of in-hospital mortality in the entire population (OR, 0.655; 95% CI, 0.505-0.850; P = 0.001), African American population (OR, 0.44; 95% CI, 0.249-0.779; P = 0.005), and non-African American population (OR, 0.748, 95% CI, 0.553-1.012, P = 0.06). In the African American population, in-hospital use of ACE-I/ARB was associated with improved mortality (OR, 0.378; 95% CI, 0.188-0.766; P = 0.006), whereas outpatient use was not (OR, 0.889; 95% CI, 0.375-2.158; P = 0.812). When analyzing each medication class separately, ARB in-hospital use was significantly associated with reduced in-hospital mortality in the African American population (OR, 0.196; 95% CI, 0.074-0.516; P = 0.001), whereas ACE-I use was not associated with impact on mortality in any population.CONCLUSIONIn-hospital use of ARB was associated with a significant reduction in in-hospital mortality among COVID-19-positive African American patients.FUNDINGNone.</abstract><cop>United States</cop><pub>American Society for Clinical Investigation</pub><pmid>34411004</pmid><doi>10.1172/JCI151418</doi><orcidid>https://orcid.org/0000-0003-2416-4395</orcidid><orcidid>https://orcid.org/0000-0002-9581-8029</orcidid><orcidid>https://orcid.org/0000-0002-2120-1704</orcidid><orcidid>https://orcid.org/0000-0001-7683-6566</orcidid><orcidid>https://orcid.org/0000-0002-1415-1286</orcidid><orcidid>https://orcid.org/0000-0002-1815-9197</orcidid><orcidid>https://orcid.org/0000-0001-6746-4297</orcidid><orcidid>https://orcid.org/0000-0001-6769-1748</orcidid><oa>free_for_read</oa></addata></record> |
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| subjects | ACE inhibitors African Americans Aged Angiotensin Receptor Antagonists - administration & dosage Angiotensin-Converting Enzyme Inhibitors - administration & dosage Clinical Medicine COVID-19 - drug therapy COVID-19 - ethnology COVID-19 - metabolism COVID-19 - mortality Disease-Free Survival Drug therapy Female Hospital Mortality - ethnology Hospital patients Humans Male Middle Aged Peptidyl-Dipeptidase A - metabolism Retrospective Studies SARS-CoV-2 - metabolism Survival Rate |
| title | In-hospital use of ACE inhibitors/angiotensin receptor blockers associates with COVID-19 outcomes in African American patients |
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