The novel coronavirus SARS-CoV-2 uses the angiotensin-converting enzyme 2 receptor as an entry point to the cell. Cardiovascular disease (CVD) is a risk factor for COVID-19 with poor outcomes. We tested the hypothesis that the rate of angiotensin-converting enzyme inhibitor (ACEI) and angiotensin receptor blocker (ARB) use is associated with the rate of COVID-19–confirmed cases and deaths. We conducted a geospatial, ecological study using publicly available county-level data. The Medicare ACEI and ARB prescription rate was exposure. The COVID-19–confirmed case and death rates were outcomes. Spatial autoregression models were adjusted for the rate of births and deaths; Group Quarters population; percentage of female; percentage of Native American, Pacific Islander, Hispanic, and Black; percentage of children and older (>65 years) adults; percentage of uninsured; percentage of those living in poverty; percentage of those who are obese, smoking, admitting insufficient sleep, and those with at least some college degree; median household income; air quality index; CVD hospitalization rate in Medicare beneficiaries; and CVD death rate in a total county population. After adjustment for confounders, the ACEI use rate did not associate with COVID-19–confirmed case rate (direct county-own effect + 0.027%; 95% confidence interval [CI] −1.080 to 1.134; p = 0.962; indirect spillover effect + 0.26%; 95% CI −70.0 to 70.5; p = 0.994). Similarly, the ARB use rate was not associated with COVID-19–confirmed case rate (direct effect + 0.029%; 95% CI −0.803 to 0.862; p = 0.945; indirect effect + 0.19%; 95% CI −52.8 to 53.2; p = 0.994). In both unadjusted and adjusted Bayesian zero inflation Poisson analysis, neither ACEI nor ARB use rates were associated with COVID-19 death rates. In conclusion, ACEI and ARB use rates were not associated with COVID-19 infectivity and death rate in this ecological study.
Cited by (0)
This work was partially supported by the National Institutes of Health (HL118277), Medical Research Foundation of Oregon (Portland, OR), and Dr. Tereshchenko received funding support from Oregon Health & Science University President Bridge funding (Portland, OR).
