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 (ARB) and HMG-CoA reductase inhibitors (‘statins’) have been hypothesised to impact COVID-19 severity. However, up till now, no studies investigating this association were conducted in the most vulnerable and affected population groups, i.e. older adults residing in nursing homes. The objective of this study has been 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 multi-centre cohort study to analyse 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, i.e. no disease symptoms in the whole study-period while still being PCR diagnosed. Setting and participants A total of 154 COVID-19 positive subjects was identified, residing in one of two 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 (OR 2.91; 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 old, frail adults could be associated with a considerable beneficial effect on COVID-19 clinical symptoms. The role of statins and renin-angiotensin system drugs need to be further explored in larger observational studies as well as randomised clinical trials.