2020 in a nutshell: The hottest developments in the field of cardiology this year. Section 1. General and preventive cardiology
From addressing the concerns of ACE inhibitors in the COVID19 era to defining a new target population for antihypertensive treatment, the following trials from 2020 will serve as landmarks for future research. Here are some of the important trials of 2020 in the field of General and preventive cardiology
1. BRACE CORONA trial
Continuing Versus Suspending Angiotensin-Converting Enzyme Inhibitors and Angiotensin Receptor Blockers
Heart patients hospitalized with COVID-19 can safely continue taking common cardiac drugs.
Membrane-bound angiotensin-converting enzyme 2 (ACE2) is the functional receptor for SARS-CoV-2. Initial concerns and conflicting observational evidence about the potential clinical impact of ACE-inhibitors and ARBs on COVID-19 patients, compelled an urgent need for randomized clinical trial evidence.
The BRACE CORONA trial was an academic-led, phase 4, randomised study testing two strategies: temporarily stopping the ACE inhibitor/ARB for 30 days versus continuing ACE inhibitors/ARBs in patients who were taking these medications chronically and were hospitalised with a confirmed diagnosis of COVID-19. The primary outcome was the number of days alive and out of hospital at 30 days.
The trial enrolled 659 patients from 29 sites in Brazil. All participants were chronically using an ACE inhibitor or ARB and were hospitalised with COVID-19. Patients were randomly allocated to stopping the ACE inhibitor/ARB for 30 days or continuing the ACE inhibitor/ARB.
The BRACE CORONA Trial concluded that with patients hospitalized with COVID-19, suspending ACE inhibitors and ARBs for 30 days did not impact the number of days alive and out of hospital, so they should generally be continued for those with an indication.
"This is the first randomised data assessing the role of continuing versus stopping ACE inhibitors and ARBs in patients with COVID-19," said principal investigator Professor Renato Lopes of Duke Clinical Research Institute, Durham, US. "In patients hospitalised with COVID-19, suspending ACE inhibitors and ARBs for 30 days did not impact the number of days alive and out of hospital."
He concluded: "Because these data indicate that there is no clinical benefit from routinely interrupting these medications in hospitalised patients with mild to moderate COVID-19, they should generally be continued for those with an indication."
Source: European heart journal: Cardiovascular Research, Volume 116, Issue 14, 1 December 2020, Pages e198–e199, https://doi.org/10.1093/cvr/cvaa325