Evidence for Use or Disuse of Renin–Angiotensin System Modulators in Patients Having COVID-19 With an Underlying Cardiorenal Disorder

Abstract

Coronavirus disease 19 (COVID-19) originated in Wuhan, China, in December 2019 has been declared pandemic by World Health Organization due to an exponential rise in the number of infected and deceased persons across the globe. Emerging reports suggest that susceptibility and mortality rates are higher in patients with certain comorbidities when compared to the average population. Cardiovascular diseases and diabetes are important risk factors for a lethal outcome of COVID-19. Extensive research ensuing the outbreak of coronavirus-related severe acute respiratory syndrome in the year 2003, and COVID-19 recently revealed a role of renin-angiotensin system (RAS) components in the entry of coronavirus wherein angiotensin-converting enzyme 2 (ACE2) had garnered the significant attention. This raises the question whether the use of RAS inhibitors, the backbone of treatment of cardiovascular, neurovascular, and kidney diseases could increase the susceptibility for coronavirus infection or unfortunate outcomes of COVID-19. Thus, currently, there is a lack of consensus regarding the effects of RAS inhibitors in such patients. Moreover, expert bodies like American Heart Association, American College of Cardiology, and so on have now released official statements that RAS inhibitors must be continued, unless suggested otherwise by a physician. In this brief review, we will elaborate on the role of RAS and ACE2 in pathogenesis of COVID-19. Moreover, we will discuss the potential effect of the use and disuse of RAS inhibitors in patients having COVID-19 with cardiometabolic comorbidities.

Older age and frailty are the chief predictors of mortality in COVID-19 patients admitted to an acute medical unit in a secondary care setting- A cohort study

“…Several pathophysiological mechanisms have been proposed that can link increased mortality in COVID-19 infected patients with cardiovascular and respiratory co-morbidities including predisposition to acute respiratory distress syndrome and myocardial injury, although the evidence is still evolving (29). Although there has been much debate regarding the impact of RASi treatment on poor outcome in COVID-19 infected patients, in our cohort, in which 25% were receiving RASi treatment, a signi cant association was not observed (OR 0.61; P=0.14) (30,31). Among the laboratory variables a lower lymphocyte count (OR 0.59; p=0.04) and a higher neutrophil: lymphocyte ratio (OR 1.05; p=0.002) were predictors of mortality which is similar to ndings in other observational studies (32).…”

Older age and frailty are the chief predictors of mortality in COVID-19 patients admitted to an acute medical unit in a secondary care setting- a cohort study

“…Several pathophysiological mechanisms have been proposed that can link increased mortality in COVID-19 infected patients with cardiovascular and respiratory co-morbidities including predisposition to acute respiratory distress syndrome and myocardial injury, although the evidence is still evolving [29]. Although there has been much debate regarding the impact of RASi treatment on poor outcome in COVID-19 infected patients, in our cohort, in which 25% were receiving RASi treatment, a significant association was not observed (OR 0.61; P = 0.14) [30,31]. Among the laboratory variables a lower lymphocyte count (OR 0.59; p = 0.04) and a higher neutrophil: lymphocyte ratio (OR 1.05; p = 0.002) were predictors of mortality which is similar to findings in other observational studies [32].…”

Older Age and Frailty are the Chief Predictors of Mortality in COVID-19 Patients Admitted to an Acute Medical Unit in a Secondary Care Setting- A Cohort Study

“…Although there has been much debate regarding the impact of RAASi treatment on poor outcome in COVID-19 infected patients, in our cohort, in which 25% were receiving RAASi treatment, a signi cant association was not observed (OR 0.61; P = 0.14) (21,22). Among the laboratory variables a lower lymphocyte count (OR 0.59; p = 0.04) and a higher neutrophil: lymphocyte ratio (OR 1.05; p = 0.002) were strong predictors of mortality which is similar to ndings in other observational studies (23).…”