Obesity and COVID-19: the ominous duet affecting the renin-angiotensin system

Minerva Endocrinol (Torino). 2021 Jun;46(2):193-201. doi: 10.23736/S2724-6507.20.03402-1. Epub 2021 Jan 12.

Abstract

The world population is facing a health challenge never seen since the Spanish influenza of one hundred years ago. During the last months, the scientific community has been debating on the potential harmful effect of angiotensin-converting-enzyme inhibitors (ACEi) or angiotensin II receptor type 1 receptor blockers (AT1-receptor blockers, ARBs) during the COVID-19 pandemic. That is because the S spike protein of SARS-CoV viruses utilizes the angiotensin-converting enzyme 2 (ACE2) as a receptor to enter alveolar epithelial cells. Obesity, often associated to type 2 Diabetes, was shown to worsen the prognosis of SARS-CoV-2 infection. Herein we discuss the complex interaction between the renin-angiotensin-aldosterone system (RAAS), its receptors, and the interaction with the Kallikrein-Kinin-system (KKS) and the potential activation of the coagulation cascade. Alteration of the equilibrium between the RAAS system and the KKS cascade may explain the frequent thromboembolic complications of COVID-19 mainly seen in obese and diabetic-obese patients. In contrast, angiotensin (1-7) contributes to maintaining a correct balance between RAAS and KKS system. Our conclusion is that the higher mortality rate in patients with obesity is linked to the alteration of RAS and RAS-KKS interaction consequent to SARS-CoV-2-cell entrance. At present, no data support the necessity of modifying ACEi or ARBs treatment in hypertensive patients.

Publication types

  • Review

MeSH terms

  • COVID-19 / complications*
  • COVID-19 / mortality
  • COVID-19 / physiopathology
  • Humans
  • Kallikrein-Kinin System
  • Obesity / complications*
  • Obesity / mortality
  • Obesity / physiopathology
  • Pandemics
  • Renin-Angiotensin System*