The Dilemma of Coronavirus Disease 2019, Aging, and Cardiovascular Disease

AlGhatrif, Majd; Cingolani, Oscar H.; Lakatta, Edward G.

doi:10.1001/jamacardio.2020.1329

Cited by 189 publications

(191 citation statements)

References 10 publications

(21 reference statements)

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“…[45] It is unfortunate that all of the included studies did not provide report on diabetic or hypertensive medications. Furthermore, the link between those specific variables could be in line with the hypothesis of AlGhatrif et al [46] Older hypertensive individuals have lower ACE2 levels but a higher RAS signalling, this difference is further expressed in COVID-19 patients in which ACE2 developed into a critically low levels and RAS signalling is exaggerated even more. Such disturbance result in a potentially decreased susceptibility to the disease, but a greater severity.…”

Section: Discussionsupporting

confidence: 81%

Diabetes mellitus is associated with increased mortality and severity of disease in COVID-19 pneumonia – A systematic review, meta-analysis, and meta-regression

Huang

Lim

Pranata

2020

Diabetes & Metabolic Syndrome: Clinical Research & Revi

777

747

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Background and AimsDiabetes Mellitus (DM) is chronic conditions with devastating multi-systemic complication and may be associated with severe form of Coronavirus Disease 2019 . We conducted a systematic review and meta-analysis in order to investigate the association between DM and poor outcome in patients with COVID-19 pneumonia. MethodsSystematic literature search was performed from several electronic databases on subjects that assess DM and outcome in COVID-19 pneumonia. The outcome of interest was composite poor outcome, including mortality, severe COVID-19, acute respiratory distress syndrome (ARDS), need for intensive care unit (ICU) care, and disease progression. ResultsThere were a total of 6452 patients from 30 studies. Meta-analysis showed that DM was associated with composite poor outcome (RR 2.38 [1.88,3.03], p<0.001; I 2 : 62%) and its subgroup which comprised of mortality (RR 2.12 [1.44, 3.11], p<0.001; I 2 : 72%), severe COVID-19 (RR 2.45 [1.79, 3.35], p<0.001; I 2 : 45%), ARDS (RR 4.64 [1.86,11.58], p=0.001; I 2 : 9%), and disease progression (RR 3.31 [1.08, 10.14], p=0.04; I 2 : 0%). Meta-regression showed that the association with composite poor outcome was influenced by age (p=0.003) and hypertension (p<0.001). Subgroup analysis showed that the association was weaker in studies with median age ≥55 years-old (RR 1.92) compared to <55 years-old (RR 3.48), and in prevalence of hypertension ≥25% (RR 1.93) compared to <25% (RR 3.06). Subgroup analysis on median age <55 years-old and prevalence of hypertension <25% showed strong association (RR 3.33) ConclusionDM was associated with mortality, severe COVID-19, ARDS, and disease progression in patients with COVID-19.

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Section: Discussionsupporting

confidence: 81%

Diabetes mellitus is associated with increased mortality and severity of disease in COVID-19 pneumonia – A systematic review, meta-analysis, and meta-regression

Huang

Lim

Pranata

2020

Diabetes & Metabolic Syndrome: Clinical Research & Revi

777

747

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“…Diaz [2] supports his recommendation on the basis of the analysis of 1099 Chinese patients infected with SARS-CoV-2, reporting more severe outcome, including death, in patients suffering from cardiovascular and kidney disorders and diabetes, that "most likely" were treated with ARBs. However, analysis of this report [2,6] revealed that the study did not address the use of ARBs in these patients. Data for previous ARB use in patients later infected with SARS-CoV-2, compared with frequency of ARB use in the general population suffering from cardiovascular disorders is not currently available.…”

Section: Dear Editormentioning

confidence: 86%

“…The statement that children may be protected from SARS-CoV-2 infection because their ACE2 is reduced with respect to that of the elderly is erroneous; ACE2 protein and enzymatic activity decline postnatally [3]. More importantly, in the elderly there is lower ACE2 expression and enhanced Angiotensin II proinflammatory effects [6]. This information supports the hypothesis of a protective effect of ARBs in older https://doi.org/10.1016/j.phrs.2020.104832 Received 23 March 2020…”

Section: Dear Editormentioning

confidence: 99%

“…Available online 15 April 2020 1043-6618/ © 2020 Elsevier Ltd. All rights reserved. T individuals, at risk of COVID-19 [6] Feng and colleagues [1] are correct when they point out that ARB treatment increases ACE2 in possible COVID-19 comorbidities such as hypertension and diabetes [1]. However, the speculation that such treatment enhances infection with this virus [1] is without scientific evidence.…”

Section: Dear Editormentioning

confidence: 99%

“…In addition, and indirectly, by upregulating ACE2, ARBs enhance the ACE2/Ang1−7/Mas axis, a mayor protective system reduced in the elderly [6] that balances Ang II and AT1R overstimulation reducing inflammation in association with down-regulation of several kinase signaling pathways [3] (Table 1).…”

Section: Dear Editormentioning

confidence: 99%

See 2 more Smart Citations

Angiotensin receptor blockers and COVID-19

Saavedra

2020

Pharmacological Research

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Predictors of mortality in hospitalized COVID‐19 patients: A systematic review and meta‐analysis

Tian

Jiang

Yao

et al. 2020

Journal of Medical Virology

553

492

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Mortality rates of coronavirus disease‐2019 (COVID‐19) continue to rise across the world. Information regarding the predictors of mortality in patients with COVID‐19 remains scarce. Herein, we performed a systematic review of published articles, from 1 January to 24 April 2020, to evaluate the risk factors associated with mortality in COVID‐19. Two investigators independently searched the articles and collected the data, in accordance with PRISMA guidelines. We looked for associations between mortality and patient characteristics, comorbidities, and laboratory abnormalities. A total of 14 studies documenting the outcomes of 4659 patients were included. The presence of comorbidities such as hypertension (odds ratio [OR], 2.5; 95% confidence interval [CI], 2.1‐3.1; P < .00001), coronary heart disease (OR, 3.8; 95% CI, 2.1‐6.9; P < .00001), and diabetes (OR, 2.0; 95% CI, 1.7‐2.3; P < .00001) were associated with significantly higher risk of death amongst patients with COVID‐19. Those who died, compared with those who survived, differed on multiple biomarkers on admission including elevated levels of cardiac troponin (+44.2 ng/L, 95% CI, 19.0‐69.4; P = .0006); C‐reactive protein (+66.3 µg/mL, 95% CI, 46.7‐85.9; P < .00001); interleukin‐6 (+4.6 ng/mL, 95% CI, 3.6‐5.6; P < .00001); D‐dimer (+4.6 µg/mL, 95% CI, 2.8‐6.4; P < .00001); creatinine (+15.3 µmol/L, 95% CI, 6.2‐24.3; P = .001); and alanine transaminase (+5.7 U/L, 95% CI, 2.6‐8.8; P = .0003); as well as decreased levels of albumin (−3.7 g/L, 95% CI, −5.3 to −2.1; P < .00001). Individuals with underlying cardiometabolic disease and that present with evidence for acute inflammation and end‐organ damage are at higher risk of mortality due to COVID‐19 infection and should be managed with greater intensity.

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The Dilemma of Coronavirus Disease 2019, Aging, and Cardiovascular Disease

Abstract: 8. Wirtz H, Hasenclever D, Schwabe K, et al. ACE inhibitor for lung protection during mechanical ventilation for acute lung injury-results of the double-blind, placebo controlled, randomised ACEmeVENT pilot study.

Cited by 189 publications

References 10 publications

Diabetes mellitus is associated with increased mortality and severity of disease in COVID-19 pneumonia – A systematic review, meta-analysis, and meta-regression

Diabetes mellitus is associated with increased mortality and severity of disease in COVID-19 pneumonia – A systematic review, meta-analysis, and meta-regression

Angiotensin receptor blockers and COVID-19

Predictors of mortality in hospitalized COVID‐19 patients: A systematic review and meta‐analysis

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