Improving Outcomes in Individuals with COVID-19 with Renin-Angiotensin System Inhibition: The COVID-RASi Trial

Cardiovascular disease is not only the #1 killer chronically, but is also the #1 killer in COVID-19. Elderly patients with previous heart attack or stroke, or hypertension or diabetes, have high risk of getting infected. Surprisingly they also suffer 3 to 5 times the chance of dying compared to other infected patients. A clue may lie in a group of commonly used medicines, called renin-angiotensin system (RAS) inhibitors, including ACE inhibitors and angiotensin receptor blocks or ARBs, usually extremely protective for our cardiovascular patients. But they have come under attack because they are suspected to increase the levels of ACE2 in the body, also part of RAS, which is the receptor for the virus, or the doorway for virus to enter our body. So are these agents safe or dangerous? This has become a major source of fear for both patients and physicians alike, and a raging controversy. To answer this question, we analyzed data from Wuhan, and found that these agents actually to be extremely protective. This finding was also replicated in another study examining patients in Europe and America. However, these data looked backwards at events past, which can be fraught with hidden biases. Therefore, the world desperately needs a proper forward-looking trial to evaluate these agents in COVID-19. Together with our Canadian and international partners experienced in COVID-19 research, we are starting this large trial to evaluate whether adding ACE inhibitors, or ARB's, compared to no added treatment in high risk COVID-19 patients, can decrease the chance of dying, requiring ventilators or ICU. A positive trial showing benefit will potentially save many lives in the world, using a very simple and cheap set of medications. Even if we found the medications to be safe, it will be very reassuring for millions of patients. We want to answer this question with urgency to benefit Canadians and cardiovascular patients worldwide in this COVID-19 era.