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May 5, 2020

Understanding Observational Treatment Comparisons in the Setting of Coronavirus Disease 2019 (COVID-19)

Author Affiliations
  • 1Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, North Carolina
  • 2Duke Clinical Research Institute, Durham, North Carolina
  • 3Assistant Editor, JAMA Cardiology
  • 4Northwestern University Feinberg School of Medicine, Chicago, Illinois
  • 5Editor, JAMA Cardiology
  • 6Deputy Editor, JAMA Cardiology
JAMA Cardiol. 2020;5(9):988-990. doi:10.1001/jamacardio.2020.1874

With the emergence of coronavirus disease 2019 (COVID-19) as a global pandemic, individuals with preexisting chronic health conditions such as hypertension, diabetes, and cardiovascular disease have been identified as particularly vulnerable.1 These patients are also more likely than the general population to be taking angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin II receptor blockers (ARBs). As the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus that causes COVID-19 gains entry into cells via binding to the angiotensin-converting enzyme 2 (ACE2) receptor,2,3 concerns have been raised that these therapies might facilitate the transmission of the virus or affect outcomes adversely.4-6 Given that ACEI and ARB therapies are known to provide benefit for the underlying conditions treated, stopping ACEI/ARB therapy carries risks. Moreover, local inactivation of the renin-angiotensin-aldosterone system may have protective effects against the development and progression of acute lung failure.3 In the absence of clinical evidence of benefit or risk of ACEIs/ARBs, current societal statements recommend against discontinuing these drugs other than for standard clinical indications.7 Robust clinical data are needed to clarify the effect of ACEIs/ARBs on SARS-CoV-2 infection.

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