ArticleBMC infectious diseases2025
Impact of ACEI/ARB use on COVID-19 mortality in patients with ischaemic heart disease: insights from South Korean National health insurance service data.
Article in BMC infectious diseases, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.
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6 authors.
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Abstract
backgroundThe COVID-19 pandemic has highlighted the importance of understanding the complex interactions between pre-existing conditions, such as ischaemic heart disease (IHD), and mortality risk. This study aims to investigate the associations among COVID-19 mortality, the presence of IHD, and the use of angiotensin receptor blockers (ARBs) and angiotensin-converting-enzyme inhibitors (ACEIs) by leveraging the South Korean National Health Insurance Service (NHIS) big data.
methodsWe conducted a retrospective cohort study of 30,056 patients with COVID-19 from the NHIS. The study population was stratified into four groups based on IHD status and the use of ACEI/ARBs. To assess their effects on mortality, we applied inverse probability of treatment weighting (IPTW) to balance baseline covariates, followed by a weighted logistic regression. The interaction between IHD and ACEI/ARB use was evaluated on both multiplicative (interaction term) and additive scales (Relative Excess Risk Due to Interaction, RERI), supplemented by an age-stratified analysis (≤ 70 vs. >70 years).
resultsAmong 30,056 COVID-19 patients, we identified a significant interaction between IHD and ACEI/ARB use on mortality after adjusting for confounders. The main finding revealed that among patients with IHD, ACEI/ARB treatment was associated with 74% lower odds of mortality compared to non-treatment (Adjusted OR: 0.26, 95% CI: 0.08-0.92, p = 0.037). This protective interaction was strongly age-dependent, remaining statistically significant only in patients older than 70 (Interaction OR: 0.53, 95% CI: 0.27-0.99; p = 0.048). Furthermore, a significant antagonistic interaction on the additive scale (RERI: - 1.77, 95% CI - 3.04 to - 0.51; p = 0.006) confirmed a combined protective effect greater than the sum of the individual effects.
conclusionsThis study leverages the NHIS big data to provide a comprehensive analysis of the complex interactions among IHD, ACEI/ARB use, demographic factors, and comorbidities in the context of COVID-19 mortality. Our findings suggest a 45% reduction in the odds of mortality for IHD patients taking ACEI/ARB, particularly those over 70 years, but randomised controlled trials are needed before clinical guideline changes. The findings highlight the protective effect of ACEI/ARB in patients with IHD and emphasize the importance of personalized treatment approaches considering patient characteristics, pre-existing conditions, and medication use.
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