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\begin{document}

\title{Cardiovascular drugs and COVID-19 clinical outcomes: a living systematic
review and meta-analysis}



\author[1]{Innocent Asiimwe}%
\author[1]{Sudeep Pushpakon}%
\author[1]{Richard Turner}%
\author[1]{Ruwanthi Kolamunnage-Dona}%
\author[1]{Andrea  Jorgensen}%
\author[1]{Munir Pirmohamed}%
\affil[1]{University of Liverpool}%


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  \date{May 23, 2024}


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\begin{abstract}
Aims: To continually evaluate the role of cardiovascular drugs in
COVID-19 clinical outcomes. Methods: Eligible publications were
identified from \textgreater{}500 databases on 1-Nov-2020. One reviewer
extracted data with 20\% of the records independently
extracted/evaluated by a second reviewer. Results: Of 52,735 screened
records, 429 and 390 studies were included in the qualitative and
quantitative syntheses, respectively. The most-reported drugs were
angiotensin-converting enzyme inhibitors (ACEIs)/angiotensin receptor
blockers (ARBs) with ACEI/ARB exposure having borderline association
with positive COVID-19 status (OR 1.14, 95\% CI 1.00--1.31). Among
COVID-19 patients, unadjusted estimates showed that ACEI/ARB exposure
was associated with hospitalization (OR 1.76, 1.34--2.32), disease
severity (OR 1.41, 1.27--1.56) and all-cause mortality (OR 1.22,
1.12--1.33) but not hospitalization length (mean difference -0.27,
-1.36; 0.82 days). After adjustment, ACEI/ARB exposure was not
associated with positive COVID-19 status (OR 0.92, 0.71--1.19),
hospitalization (OR 0.93, 0.70--1.24), disease severity (OR 1.05,
0.81--1.38), or all-cause mortality (OR 0.85, 0.71--1.01). Similarly,
subgroup analyses involving only hypertensive patients revealed that
ACEI/ARB exposure was not associated with positive COVID-19 status (OR
0.93, 0.79--1.09), hospitalization (OR 0.84, 0.58--1.22),
hospitalization length (mean difference -0.14, -1.65; 1.36 days),
disease severity (OR 0.92, 0.76--1.11) while it decreased the odds of
dying (OR 0.76, 0.65--0.88). A similar trend was observed for other
cardiovascular drugs. However, the validity of these findings is limited
by a high level of heterogeneity and serious risk of bias. Conclusion:
Cardiovascular drugs are not associated with poor COVID-19 outcomes in
adjusted analyses. Patients should continue taking these drugs as
prescribed.%
\end{abstract}%



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