Covid-19 and cardiovascular risk: Susceptibility to infection to SARS-CoV-2, severity and prognosis of Covid-19 and blockade of the renin-angiotensin-aldosterone system. An evidence-based viewpoint

Nutr Metab Cardiovasc Dis. 2020 Jul 24;30(8):1227-1235. doi: 10.1016/j.numecd.2020.05.013. Epub 2020 May 29.

Abstract

The presence of cardiovascular co-morbidities and the known effects of coronaviruses on the cardiovascular system have called attention to the potential implications for patients with cardiovascular risk factors. This evidence-based viewpoint will address two questions: (a) are individuals with underlying cardiovascular risk factors (e.g. high blood pressure or diabetes) or overt disease (e.g. coronary heart disease, heart failure, kidney disease) more likely to develop severe Covid-19 and to die than those without underlying conditions? (b) does the regular use of angiotensin-converting enzyme inhibitors (ACE-i) or angiotensin-receptor blockers (ARB) make patients more likely to get infected and to die of Covid-19? With a necessary cautionary note that the evidence around the links between Covid-19 and cardiovascular disease is accruing at a fast pace, to date we can conclude that: (a) the greater susceptibility of individuals with underlying cardiovascular conditions to develop more severe Covid-19 with higher mortality rate is likely to be confounded, in part, by age and the type of co-morbidities. Patients with heart failure or chronic kidney disease might show an excess risk; (b) neither ACE-i nor ARB are associated with greater risk of SARS-Cov2 infection, or severity or risk of death in patients with Covid-19. Patients on these drugs should not stop them, unless under strict medical supervision and with the addition of a suitable replacement medicine.

Keywords: ACE-Inhibitors; Angiotensin-receptor-blockers; Cardiovascular disease; Covid-19; Diabetes; Hypertension; Renin-angiotensin system; SARS-CoV-2.

MeSH terms

  • Aged
  • Angiotensin Receptor Antagonists / therapeutic use
  • Angiotensin-Converting Enzyme Inhibitors / therapeutic use
  • Betacoronavirus*
  • COVID-19
  • Cardiovascular Diseases / complications*
  • Coronavirus Infections / etiology*
  • Coronavirus Infections / mortality
  • Humans
  • Middle Aged
  • Pandemics
  • Pneumonia, Viral / etiology*
  • Pneumonia, Viral / mortality
  • Prognosis
  • Renin-Angiotensin System / physiology
  • SARS-CoV-2

Substances

  • Angiotensin Receptor Antagonists
  • Angiotensin-Converting Enzyme Inhibitors