Cardiovascular Disease and Use of Renin-Angiotensin System Inhibitors in COVID-19

Kow, Chia Siang; Zaidi, Syed Tabish Razi; Hasan, Syed Shahzad

doi:10.1007/s40256-020-00406-0

Cited by 25 publications

(21 citation statements)

References 41 publications

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“…Medication that blocks the renin-angiotensin-aldosterone system (RAAS), including angiotensin-converting enzyme inhibitors (ACEI) and angiotensin Ⅱ receptor blockers (ARBs), are commonly used. They increase ACE 2 levels abstractly and lead to more severe diseases in patients ( Kow et al, 2020 ; Mali et al, 2020 ). However, the role of ACE 2 in coronavirus infection remains controversial and there are insufficient clinical data to prove it ( Gross et al, 2020 ).…”

Section: Discussionmentioning

confidence: 99%

Cardio-Cerebrovascular Disease is Associated With Severity and Mortality of COVID-19: A Systematic Review and Meta-Analysis

Yang

et al. 2020

Biological Research For Nursing

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At present, COVID-19 is raging all over the world. Many comorbidities, such as diabetes mellitus (OR = 2.67, 95% CI = 1.91–3.74) and hypertension (OR = 2.3, 95% CI = 1.76–3.00), have been shown to worsen the patient’s condition. However, whether cardio-cerebrovascular disease will affect COVID-19 remains unclear. In this meta-analysis, we collected studies from PubMed, Wed of Science and CNKI (Chinese) to July 25, which reported COVID-19 patients with and without cardio-cerebrovascular disease as well as their severity and mortality. The random-effect model meta-analysis was used to analyze them and get overall odds ratios (OR) with 95% CIs. Funnel plots and the Begg’s and Egger’s test were used to assess publication bias. Thirty-one studies with 23,632 patients were finally included in the meta-analysis. The results showed an OR of 3.004 (95% CI = 2.097–4.303) for COVID-19 severity and an OR of 5.587 (95% CI = 2.810–11.112) for COVID-19 mortality. Compared with cardiovascular disease, the subgroup analysis indicated that cerebrovascular disease was more likely to increase the severity (OR = 3.400, 95% CI = 1.569–7.368) and mortality (OR = 23.477, 95% CI = 3.050–180.735) of COVID-19. Therefore, it can be inferred that cardio-cerebrovascular disease is associated with an increase in the risk of severe illness and death among COVID-19 patients. This meta-analysis showed that cardio-cerebrovascular disease has a significant relation with severe and death outcomes of COVID-19. Nurses should pay special attention to COVID-19 patients with the cardio-cerebrovascular disease.

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Section: Discussionmentioning

confidence: 99%

Cardio-Cerebrovascular Disease is Associated With Severity and Mortality of COVID-19: A Systematic Review and Meta-Analysis

Yang

et al. 2020

Biological Research For Nursing

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“…Two possible explanations for the increased prevalence and mortality among patients with comorbid cardiovascular disease have been proposed. Firstly, cardiovascular disease is commonly treated with renin angiotensin system inhibitors as described above ( 72 , 73 ), and secondly, ACE2 is highly expressed in the heart ( 74 ). A recent study analyzing the cellular distribution of ACE2 in human heart tissue obtained from COVID-19 patients identified that ACE2 was highly expressed in pericytes, cardiomyocytes and fibroblasts ( 75 ).…”

Section: Impact Of Pre-existing Comorbiditiesmentioning

confidence: 99%

The Impact of Pre-existing Comorbidities and Therapeutic Interventions on COVID-19

et al. 2020

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Evidence from the global outbreak of SARS-CoV-2 has clearly demonstrated that individuals with pre-existing comorbidities are at a much greater risk of dying from COVID-19. This is of great concern for individuals living with these conditions, and a major challenge for global healthcare systems and biomedical research. Not all comorbidities confer the same risk, however, many affect the function of the immune system, which in turn directly impacts the response to COVID-19. Furthermore, the myriad of drugs prescribed for these comorbidities can also influence the progression of COVID-19 and limit additional treatment options available for COVID-19. Here, we review immune dysfunction in response to SARS-CoV-2 infection and the impact of pre-existing comorbidities on the development of COVID-19. We explore how underlying disease etiologies and common therapies used to treat these conditions exacerbate COVID-19 progression. Moreover, we discuss the long-term challenges associated with the use of both novel and repurposed therapies for the treatment of COVID-19 in patients with pre-existing comorbidities.

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“…Several learned cardiovascular societies have discredited the association between RAS inhibitors and the increased susceptibility to COVID-19 or associated poor outcomes and encouraged clinicians and patients to continue the use of prescribed RAS inhibitors in hypertension or other established indications [ 27 ]. In addition, several observational studies have since reported clinical outcomes among patients with COVID-19 receiving RAS inhibitors [ 35 – 93 ].…”

Section: Introductionmentioning

confidence: 99%

Mortality and Disease Severity Among COVID-19 Patients Receiving Renin-Angiotensin System Inhibitors: A Systematic Review and Meta-analysis

Hasan

Kow

Hadi

et al. 2020

Am J Cardiovasc Drugs

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Introduction The use of renin-angiotensin system (RAS) inhibitors, including angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs), was alleged to cause a more severe course of novel coronavirus disease 2019 (COVID-19). Methods We systematically reviewed the published studies to assess the association of RAS inhibitors with mortality as well as disease severity in COVID-19 patients. A systematic literature search was performed to retrieve relevant original studies investigating mortality and severity (severe/critical disease) in COVID-19 patients with and without exposure to RAS inhibitors. Results A total of 59 original studies were included for qualitative synthesis. Twenty-four studies that reported adjusted effect sizes (24 studies reported mortality outcomes and 16 studies reported disease severity outcomes), conducted in RAS inhibitor-exposed and unexposed groups, were pooled in random-effects models to estimate overall risk. Quality assessment of studies revealed that most of the studies included were of fair quality. The use of an ACEI/ARB in COVID-19 patients was significantly associated with lower odds (odds ratio [OR] = 0.73, 95% confidence interval [CI] 0.56-0.95; n = 18,749) or hazard (hazard ratio [HR] = 0.75, 95% CI 0.60-0.95; n = 26,598) of mortality compared with non-use of ACEI/ARB. However, the use of an ACEI/ARB was non-significantly associated with lower odds (OR = 0.91, 95% CI 0.75-1.10; n = 7446) or hazard (HR = 0.73, 95% CI 0.33-1.66; n = 6325) of developing severe/critical disease compared with non-use of an ACEI/ARB. Discussion Since there was no increased risk of harm, the use of RAS inhibitors for hypertension and other established clinical indications can be maintained in COVID-19 patients.

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Cardiovascular Disease and Use of Renin-Angiotensin System Inhibitors in COVID-19

Cited by 25 publications

References 41 publications

Cardio-Cerebrovascular Disease is Associated With Severity and Mortality of COVID-19: A Systematic Review and Meta-Analysis

Cardio-Cerebrovascular Disease is Associated With Severity and Mortality of COVID-19: A Systematic Review and Meta-Analysis

The Impact of Pre-existing Comorbidities and Therapeutic Interventions on COVID-19

Mortality and Disease Severity Among COVID-19 Patients Receiving Renin-Angiotensin System Inhibitors: A Systematic Review and Meta-analysis

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