Cardiovascular Implications of Fatal Outcomes of Patients With Coronavirus Disease 2019 (COVID-19)

Guo, Tao; Fan, Yongzhen; Chen, Ming; Wu, Xiaoyan; Zhang, Lin; He, Tao; Wang, Hairong; Wan, Jing; Wang, Xinghuan; Lu, Zhibing

doi:10.1001/jamacardio.2020.1017

Cited by 3,596 publications

(4,880 citation statements)

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“…In a study of 187 patients with COVID-19, Guo et al reported an increased trend in mortality with those receiving RASB, compared to those not receiving. Mortality was 36.8% (6 of 19) and 25.6% (43 of 168) in patients with or without RASB, respectively [14]. Indeed, increased association and heightened mortality with COVID-19 have been observed consistently across the studies in elderly, hypertensive, diabetics and known CVD; however, it is not exactly known whether it has any causal relation with the use of RASB or these subgroups are more on RASB due to these illness, compared to the rest of population.…”

Section: Effects Of Ace Inhibitors and Angiotensin Receptor Blockersmentioning

confidence: 97%

“…It should be noted however, that neither of these studies were adjusted for all confounding variables. Nevertheless, a study of 187 patients with COVID-19, Guo et al reported nearly a twice increase in mortality in patients with established CVD and raised troponin T (TnT), compared to patients without CVD and raised TnT (69.4% vs. 37.5% respectively) [14].…”

Section: Hypertension As a Prognostic Indicator For Severity And Mortmentioning

confidence: 99%

“…With regards to the use of RASB, a retrospective analysis of 112 COVID-19 hospitalised patients with cardiovascular disease in Wuhan, there was no significant difference in the proportion of ACEI/ARB medication between non-survivors and survivors [47]. However, a study of 187 patient reported by Guo et al, there was a trend of increase in mortality in patients with COVID-19 receiving RASB (36.8%), compared to those not receiving (25.6%) [14].…”

Section: Effects Of Ace Inhibitors and Angiotensin Receptor Blockersmentioning

confidence: 99%

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Comorbidities in COVID-19: Outcomes in hypertensive cohort and controversies with renin angiotensin system blockers

Singh

Gupta

Misra

2020

Diabetes & Metabolic Syndrome: Clinical Research & Revi

206

156

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a b s t r a c tBackground and aims: COVID-19 is already a pandemic. Emerging data suggest an increased association and a heightened mortality in patients of COVID-19 with comorbidities. We aimed to evaluate the outcome in hypertensive patients with COVID-19 and its relation to the use of renin-angiotensin system blockers (RASB). Methods: We have systematically searched the medical database up to March 27, 2020 and retrieved all the published articles in English language related to our topic using MeSH key words. Results: From the pooled data of all ten available Chinese studies (n ¼ 2209) that have reported the characteristics of comorbidities in patients with COVID-19, hypertension was present in nearly 21%, followed by diabetes in nearly 11%, and established cardiovascular disease (CVD) in approximately 7% of patients. Although the emerging data hints to an increase in mortality in COVID-19 patients with known hypertension, diabetes and CVD, it should be noted that it was not adjusted for multiple confounding factors. Harm or benefit in COVID-19 patients receiving RASB has not been typically assessed in these studies yet, although mechanistically and plausibly both, benefit and harm is possible with these agents, given that COVID-19 expresses to tissues through the receptor of angiotensin converting enzyme-2. Conclusion: Special attention is definitely required in patients with COVID-19 with associated comorbidities including hypertension, diabetes and established CVD. Although the role of RASB has a mechanistic equipoise, patients with COVID-19 should not stop these drugs at this point of time, as recommended by various world organizations and without the advice of health care provider.

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Section: Effects Of Ace Inhibitors and Angiotensin Receptor Blockersmentioning

confidence: 97%

Section: Hypertension As a Prognostic Indicator For Severity And Mortmentioning

confidence: 99%

Section: Effects Of Ace Inhibitors and Angiotensin Receptor Blockersmentioning

confidence: 99%

See 1 more Smart Citation

Comorbidities in COVID-19: Outcomes in hypertensive cohort and controversies with renin angiotensin system blockers

Singh

Gupta

Misra

2020

Diabetes & Metabolic Syndrome: Clinical Research & Revi

206

156

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“…Several studies have identified older age and baseline burden of comorbidity, such as diabetes, hypertension, prior coronary disease and prior lung disease, as predictors of more significant disease progression with higher rates of ARDS, AKI, cardiac injury, ICU admission and death (51)(52)(53)58,59). Increases in markers of inflammation, coagulation, and cardiac injury also correlate with disease severity and rise throughout the course of the disease (53,54,56). In hospitalized populations, the timing of death occurred at a median of 16-19 days after illness onset (53,58).…”

Section: Disease Progressionmentioning

confidence: 99%

“…Numerous studies have reported acute cardiac injury as an important manifestation of COVID- 19. In studies published to date, acute cardiac injury was variably defined as either cardiac troponin elevation >99 th percentile alone or a composite of troponin elevation, ECG or echocardiographic abnormalities (52)(53)(54)(55)(56)58). Importantly, many aspects of this endpoint remain undefined including the frequency and severity of associated structural abnormalities.…”

Section: Cardiac Injurymentioning

confidence: 99%

COVID-19 for the Cardiologist

Atri

Siddiqi

Lang

et al. 2020

JACC: Basic to Translational Science

254

137

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Highlights-Severe acute respiratory virus-2 (SARS-CoV2), the infection responsible for coronavirus disease-2019 (COVID-19), has spread globally leading to a devastating loss of life. In a few short months, the clinical and scientific communities have rallied to rapidly evolve our understanding of the mechanism(s) of disease and potential therapeutics. -This review discusses the current understanding of the basis virology of SARS-CoV2 and the epidemiology, clinical manifestations, including cardiovascular, and mortality of COVID-19. A detailed review of the viral life cycle and putative mechanism(s) of injury frames the discussion of possible preventative and therapeutic strategies. -The ongoing, unprecedented collective effort will, without a doubt, advance our ability to prevent the spread and optimally care for patients suffering from COVID-19. SummaryThe coronavirus disease-2019 (COVID-19), a contagious disease caused by severe acute respiratory syndrome coronavirus-2 (SARS-CoV2), has reached pandemic status. As it spreads across the world, it has overwhelmed healthcare systems, strangled the global economy and led to a devastating loss of life. Widespread efforts from regulators, clinicians and scientists are driving a rapid expansion of knowledge of the SARS-CoV2 virus and the COVID-19 disease.We review the most current data with a focus on our basic understanding of the mechanism(s) of disease and translation to the clinical syndrome and potential therapeutics. We discuss the basic virology, epidemiology, clinical manifestation, multi-organ consequences, and outcomes. With a focus on cardiovascular complications, we propose several mechanisms of injury. The virology and potential mechanism of injury form the basis for a discussion of potential disease-modifying therapies.

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Effect of Discontinuing vs Continuing Angiotensin-Converting Enzyme Inhibitors and Angiotensin II Receptor Blockers on Days Alive and Out of the Hospital in Patients Admitted With COVID-19

Lópes

Macedo

Silva³

et al. 2021

JAMA

315

312

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It is unknown whether angiotensin-converting enzyme inhibitors (ACEIs) or angiotensin II receptor blockers (ARBs) have a positive, neutral, or negative effect on clinical outcomes in patients with coronavirus disease 2019 (COVID-19).OBJECTIVE To determine whether discontinuation compared with continuation of ACEIs or ARBs changed the number of days alive and out of the hospital through 30 days. DESIGN, SETTING, AND PARTICIPANTSA randomized clinical trial of 659 patients hospitalized in Brazil with mild to moderate COVID-19 who were taking ACEIs or ARBs prior to hospitalization

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Cardiovascular Implications of Fatal Outcomes of Patients With Coronavirus Disease 2019 (COVID-19)

Cited by 3,596 publications

References 16 publications

Comorbidities in COVID-19: Outcomes in hypertensive cohort and controversies with renin angiotensin system blockers

Comorbidities in COVID-19: Outcomes in hypertensive cohort and controversies with renin angiotensin system blockers

COVID-19 for the Cardiologist

Effect of Discontinuing vs Continuing Angiotensin-Converting Enzyme Inhibitors and Angiotensin II Receptor Blockers on Days Alive and Out of the Hospital in Patients Admitted With COVID-19

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