Association of Cardiovascular Medications With Adverse Outcomes in a Matched Analysis of a National Cohort of Patients With COVID-19

Wang, Leonard Kuan‐Pei; Kuo, Yong–Fang; Westra, Jordan; Raji, Mukaila; Albayyaa, Mohanad A.; Allencherril, Joseph; Baillargeon, Jacques

doi:10.1016/j.ajmo.2023.100040

Cited by 4 publications

(2 citation statements)

References 56 publications

(82 reference statements)

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“…It is now generally accepted that potential benefits outweigh the harms of RAAS blockers for COVID-19 patients. It was recently shown that CVD medications, including statins, ACEI/ARBs, and anticoagulants were associated with decreased risks of hospitalization and adverse outcomes of COVID-19 [14]. A cohort study in 2022 found that administration of ARBs was not associated with the risk of in-hospital and 7-month all-cause mortality, complications, and poorer outcomes in hypertensive COVID-19 patients, but discontinuation of ARBs led to higher in-hospital mortality and 7-month all-cause mortality [15].…”

Section: Ace2 and Cardiovascular Complicationsmentioning

confidence: 99%

“…Acute MI is a severe form of myocardial injury with pathological characteristics such as (1) new ischemic ECG changes (e.g., development of pathological Q waves); (2) imaging evidence of new loss of viable myocardium or new regional wall motion abnormality in a pattern consistent with an ischemic etiology; and (3) identification of a coronary thrombus by angiography including intracoronary imaging and requires emergency noninterventional or interventional treatment. SARS-CoV-2 infection may trigger three of the four types of MI defined by the fourth universal definition: type 1, type 2, and type 4b [14]. Type 1 MI is caused by atherothrombotic CAD.…”

Section: Acute MImentioning

confidence: 99%

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Pathological Interplay and Clinical Complications between COVID-19 and Cardiovascular Diseases: An Overview in 2023

Zhou,

Zhang,

Liao

et al. 2023

Cardiology

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The coronavirus disease 2019 (COVID-19) involves all organs of the body, of which the interaction with cardiovascular diseases is the most important. Numerous studies have reported that COVID-19 patients complicated with cardiovascular comorbidities (hypertension, coronary heart disease, chronic heart failure, cerebrovascular disease) are more likely to develop into critical illness and have higher mortality. Conversely, COVID-19 may also cause myocardial injury in patients through various pathological mechanisms such as direct virus attack on cardiomyocytes, overactivation of immune response, microthrombus formation, which may lead to fatal acute ST-segment elevation myocardial infarction, arrhythmia, acute worsening of chronic heart failure, etc. In addition, the symptoms of the so-called long-COVID may remain in some patients who survived the acute viral infection. Positional tachycardia has been widely reported, and cardiovascular autonomic disorders are thought to play a pathogenic role.

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Section: Ace2 and Cardiovascular Complicationsmentioning

confidence: 99%

Section: Acute MImentioning

confidence: 99%

Pathological Interplay and Clinical Complications between COVID-19 and Cardiovascular Diseases: An Overview in 2023

Zhou,

Zhang,

Liao

et al. 2023

Cardiology

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Overreactive macrophages in SARS-CoV-2 infection: The effects of ACEI

Felkle,

Zięba,

Kaleta

et al. 2023

International Immunopharmacology

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Hypercapnia increases ACE2 expression and pseudo-SARS-CoV-2 entry in bronchial epithelial cells by augmenting cellular cholesterol

Chen,

Matsuda,

Budinger

et al. 2023

Front. Immunol.

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Patients with chronic lung disease, obesity, and other co-morbid conditions are at increased risk of severe illness and death when infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Hypercapnia, the elevation of CO2 in blood and tissue, commonly occurs in patients with severe acute and chronic lung disease, including those with pulmonary infections, and is also associated with high mortality risk. We previously reported that hypercapnia increases viral replication and mortality of influenza A virus infection in mice. We have also shown that culture in elevated CO2 upregulates expression of cholesterol synthesis genes in primary human bronchial epithelial cells. Interestingly, factors that increase the cholesterol content of lipid rafts and lipid droplets, platforms for viral entry and assembly, enhance SARS-CoV-2 infection. In the current study, we investigated the effects of hypercapnia on ACE2 expression and entry of SARS-CoV-2 pseudovirus (p-SARS-CoV-2) into airway epithelial cells. We found that hypercapnia increased ACE2 expression and p-SARS-CoV-2 uptake by airway epithelium in mice, and in cultured VERO and human bronchial epithelial cells. Hypercapnia also increased total cellular and lipid raft-associated cholesterol in epithelial cells. Moreover, reducing cholesterol synthesis with inhibitors of sterol regulatory element binding protein 2 (SREBP2) or statins, and depletion of cellular cholesterol, each blocked the hypercapnia-induced increases in ACE2 expression and p-SARS-CoV-2 entry into epithelial cells. Cigarette smoke extract (CSE) also increased ACE2 expression, p-SARS-CoV-2 entry and cholesterol accumulation in epithelial cells, an effect not additive to that of hypercapnia, but also inhibited by statins. These findings reveal a mechanism that may account, in part, for poor clinical outcomes of SARS-CoV-2 infection in patients with advanced lung disease and hypercapnia, and in those who smoke cigarettes. Further, our results suggest the possibility that cholesterol-lowering therapies may be of particular benefit in patients with hypercapnia when exposed to or infected with SARS-CoV-2.

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Association of Cardiovascular Medications With Adverse Outcomes in a Matched Analysis of a National Cohort of Patients With COVID-19

Cited by 4 publications

References 56 publications

Pathological Interplay and Clinical Complications between COVID-19 and Cardiovascular Diseases: An Overview in 2023

Pathological Interplay and Clinical Complications between COVID-19 and Cardiovascular Diseases: An Overview in 2023

Overreactive macrophages in SARS-CoV-2 infection: The effects of ACEI

Hypercapnia increases ACE2 expression and pseudo-SARS-CoV-2 entry in bronchial epithelial cells by augmenting cellular cholesterol

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