Impact of Angiotensin-Converting Enzyme Inhibitors Administration Prior to Acute Ischemic Stroke Onset on In-Hospital Mortality

Abstract Ischemic stroke is a common cause of death. The role of statins in the secondary prevention of the chronic ischemic stroke phase has been established. However, evidence regarding their efficacy in this phase is limited and contradictory. Objective: To evaluate the association between statin use and mortality risk during the acute phase of ischemic stroke in patients admitted to an intensive care unit. Methods: This was an observational and prospective study of ischemic stroke patients aged ≥18, admitted to an intensive care unit. Medications used during the first 7 days after the ictus, as well as medications used previously, were recorded. The primary outcome was all-cause mortality during the first 7 days. Results: We screened 212 patients and included 97 patients with ischemic stroke in the study period. The mortality rate among patients who used statins during the acute IS phase [14% (9/63)] was significantly lower than that among patients who did not use statins [41% (14/34); p=0.007]. This was confirmed in logistical regression with an 0.19 Odds Ratio - OR [p=0.018; 95% confidence interval - 95%CI 0.05-0.75]. Patients who died were older, had a higher incidence of acute myocardial infarction, higher scores on the NIHSS and lower systolic blood pressure. Statins and angiotensin converting enzyme inhibitors were used more frequently among survivors. These associations persisted even after adjustment for confounding variables. Conclusion: Statins and angiotensin converting enzyme inhibitors use during hospitalization were independently associated to a lower rate of all-cause mortality in the first 7 days of intensive care unit admission.

Download Full-text

Effect of Prestroke Use of Angiotensin-Converting Enzyme Inhibitors Alone Versus Combination With Antiplatelets and Statin on Ischemic Stroke Outcome

Clinical Neuropharmacology ◽

10.1097/wnf.0b013e3182348abe ◽

2011 ◽

Vol 34 (6) ◽

pp. 234-240 ◽

Cited By ~ 2

Author(s):

Yahaya Hassan ◽

Samah W. Al-Jabi ◽

Noorizan Abd Aziz ◽

Irene Looi ◽

Sa’ed H. Zyoud

Keyword(s):

Ischemic Stroke ◽

Angiotensin Converting Enzyme ◽

Enzyme Inhibitors ◽

Angiotensin Converting Enzyme Inhibitors ◽

Stroke Outcome ◽

Converting Enzyme ◽

Converting Enzyme Inhibitors

Download Full-text

Abstract P144: Covid-19 And The Use Of Angiotensin-converting Enzyme Inhibitors And Receptor Blockers. Real World Experience.

Hypertension ◽

10.1161/hyp.76.suppl_1.p144 ◽

2020 ◽

Vol 76 (Suppl_1) ◽

Author(s):

Baher AL Abbasi ◽

Nakeya Dewaswala ◽

Fergie Ramos ◽

Ahmed Abdallah ◽

Pedro Torres ◽

...

Keyword(s):

Diabetes Mellitus ◽

Chronic Kidney Disease ◽

Kidney Disease ◽

Angiotensin Converting Enzyme ◽

Hospital Mortality ◽

Enzyme Inhibitors ◽

Angiotensin Converting Enzyme Inhibitors ◽

Converting Enzyme ◽

Converting Enzyme Inhibitors ◽

Receptor Blockers

Background: Concerns exist that angiotensin-converting enzyme inhibitors (ACEI) and angiotensin receptor blockers (ARBs) increase susceptibility to coronavirus SARS CoV-2 (the virus that causes the disease COVID-19) and the likelihood of severe COVID-19 illness. Methods: This is a single-center retrospective cohort study of 172 patients diagnosed with 2019 Novel Coronavirus (SARS-CoV-2) between March of 2020 and May of 2020. Our study aimed to investigate the impact of ACEI and/or ARBs on the in-hospital mortality, intensive care unit (ICU) admission, hospital length of stay (LOS), and ICU LOS of patients with COVID-19. Results: This cohort of 172 patients included 88 (51%) women with a mean age of 58±17 years. Patients who had a history of using ACEI/ARBs were older 68±14 vs. 54±17 (P<0.0001). They were more likely to be obese 28(65%) vs. 52(40%) p=0.0054, have hypertension 44(100%) vs 42(33%) p<0.0001, diabetes mellitus 18(40%) vs 13 (10%) p<0.0001, and chronic kidney disease 5(11%) vs. 1(0.8%) p= 0.0011 than patients not using ACEI/ARBs. On the other hand, the prevalence of coronary artery disease (p=0.3791), and chronic heart failure (p=0.8037) was similar between the two groups. Outcomes: There was significantly higher in-hospital mortality in patients who used ACEI/ARBs than non-users (33% vs. 13%, p=0.0039, respectively). To evaluate the effect of ACEI/ARBs on mortality after controlling for confounding factors, multivariable logistic regression (MLR) was performed based on age (p=0.0003), obesity (p=0.3394), hypertension (p=0.4159), diabetes mellitus (p=0.0144), and chronic kidney disease (0.3189). The MLR showed no significant differences in mortality between patients who used ACEI/ARBs and non-users (p= 0.8372). Admission to ICU was more likely in patients who used ACEI/ARBs than non-users (28% vs. 13%, p=0.0384 respectively), while hospital LOS (6±9 vs. 4±6, p=0.1240 respectively), and ICU LOS (12±12 vs. 8±5, p= 0.3253 respectively) were similar between the two groups. Conclusion: This study suggests that the use of ACEI/ARBs associated with higher mortality in patients with COVID-19. This is likely attributed to the fact that patients who use these medications are older and are more likely to have diabetes mellitus and hypertension.

Download Full-text