scholarly journals Protecting older patients with cardiovascular diseases from COVID-19 complications using current medications

2021 ◽  
Author(s):  
Mariana Alves ◽  
◽  
Marília Andreia Fernandes ◽  
Gülistan Bahat ◽  
Athanase Benetos ◽  
...  
Keyword(s):  
Cardiovascular Diseases ◽  
Older Patients ◽  
Observational Studies ◽  
Angiotensin Receptor Blockers ◽  
Cardiovascular Drugs ◽  
Pulmonary Vasodilators ◽  
Clinical Databases ◽  
Drug Classes ◽  
Receptor Blockers ◽  
Randomised Controlled

Abstract Purpose In the pathogenesis of severe COVID-19 complications, derangements of renin–angiotensin–aldosterone system (RAAS), vascular endothelial dysfunction leading to inflammation and coagulopathy, and arrhythmias play an important role. Therefore, it is worth considering the use of currently available drugs to protect COVID-19 patients with cardiovascular diseases. Methods We review the current experience of conventional cardiovascular drugs [angiotensin-converting enzyme (ACE) inhibitors, angiotensin receptor blockers, anticoagulants, acetosalicylic acid, antiarrhythmic drugs, statins] as well as some other drug classes (antidiabetic drugs, vitamin D and NSAIDs) frequently used by older patients with cardiovascular diseases. Data were sought from clinical databases for COVID-19 and appropriate key words. Conclusions and recommendations are based on a consensus among all authors. Results Several cardiovascular drugs have a potential to protect patients with COVID-19, although evidence is largely based on retrospective, observational studies. Despite propensity score adjustments used in many analyses observational studies are not equivalent to randomised controlled trials (RCTs). Ongoing RCTs include treatment with antithrombotics, pulmonary vasodilators, RAAS-related drugs, and colchicine. RCTs in the acute phase of COVID-19 may not, however, recognise the benefits of long term anti-atherogenic therapies, such as statins. Conclusions Most current cardiovascular drugs can be safely continued during COVID-19. Some drug classes may even be protective. Age-specific data are scarce, though, and conditions which are common in older patients (frailty, comorbidities, polypharmacy) must be individually considered for each drug group.

scholarly journals Combined RAAS and NEP Inhibition

2019 ◽  
Vol 17 ◽  
Author(s):  
Giuseppe Vergaro ◽  
Marco Metra
Keyword(s):  
Enzyme Inhibitors ◽  
Beta Blockers ◽  
Angiotensin Receptor Blockers ◽  
Angiotensin Converting Enzyme Inhibitors ◽  
Angiotensin Receptor ◽  
Mineralocorticoid Receptor Antagonists ◽  
Converting Enzyme Inhibitors ◽  
Drug Classes ◽  
Receptor Blockers ◽  
Nep Inhibition

The neurohormonal model of HF has provided the rationale for the use of drug classes blocking the effectors of both the RAAS and SNS at different sites, including angiotensin-converting enzyme inhibitors (ACEI), angiotensin receptor blockers (ARB), mineralocorticoid receptor antagonists (MRA), and beta-blockers. Combined NEP and ACE blockade although unsuccessful with omapatrilat in the OVERTURE trial, found success with sacubitril/valsartan in the Paradigm-HF trial. The results of PARADIGM-HF trial represent one of the most significant breakthroughs in the management of HF of the last decade, representing a shift from neurohomonal antagonism to neurohormonal modulation.

scholarly journals Practical considerations for cardiovascular care during COVID-19 pandemic

2021 ◽  
Author(s):  
Dnyanoba Kishanrao Bhaskar ◽  
Vishal Madanlal Chaudhari ◽  
Medha Ajit Oak
Keyword(s):  
Information Overload ◽  
Enzyme Inhibitors ◽  
Angiotensin Receptor Blockers ◽  
Angiotensin Converting Enzyme Inhibitors ◽  
Routine Care ◽  
Adverse Outcomes ◽  
Converting Enzyme Inhibitors ◽  
Global Pandemic ◽  
Drug Classes ◽  
Receptor Blockers

Coronavirus disease 2019 (COVID-19), caused by a strain of coronavirus known as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has triggered a global pandemic affecting billions of lives and posing a stiff challenge to the delivery of routine healthcare across the world. The new second wave of COVID-19 in India presents with higher rate of infection and percentage of asymptomatic and mildly symptomatic cases is much higher than before, which means more people are spreading the disease. People with co-morbidities such as pre-existing cardiovascular conditions are at risk of suffering from severe complications of COVID-19 including acute respiratory distress and multi-organ failure. The pandemic has also resulted in people deferring routine care for conditions such as hypertension, diabetes and other cardiometabolic diseases. Initial reports also linked major CV drug classes such as the angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs) to adverse outcomes in COVID-19 patients. While subsequent reports have disproved these earlier findings, the science is rapidly evolving and the information overload has served to confuse general practitioners and consultant physicians alike. This review examined the practical considerations in terms of cardiocascular complications, effect of drugs, older adults and tele-consultation for CV care during COVID-19 pandemic.

scholarly journals COVID-19 pandemic and cardiovascular disease

2020 ◽  
Vol 27 (2) ◽  
pp. 10-17
Author(s):  
V. M. Kovalenko ◽  
E. G. Nesukay ◽  
T. M. Kornienko ◽  
N. S. Titova
Keyword(s):  
Cardiovascular Diseases ◽  
Angiotensin Receptor Blockers ◽  
World Health ◽  
Angiotensin Converting Enzyme 2 ◽  
Global Pandemic ◽  
Key Enzyme ◽  
Mechanism Of Interaction ◽  
Receptor Blockers ◽  
Health Organization ◽  
Functional Receptor

The World Health Organization announced on March 11, 2020 that coronavirus disease 2019 (COVID-19) is a global pandemic. The data of studies confirming that cardiovascular diseases are a common concomitant pathology among patients with COVID-19 and cardiological patients have a more severe course and high mortality are presented. The mechanism of interaction between COVID-19 and cardiovascular diseases has been identified. First, angiotensin-converting enzyme-2 (ACE2), a key enzyme in the renin-angiotensin-aldosterone system, is recognized as a functional receptor for SARS-CoV-2. Secondly, it was proved that SARS-CoV-2 through the cytokine mechanism causes direct damage to the myocardium and can disrupt the function of the cardiovascular system. This review highlights the need for continued use of ACE inhibitors and angiotensin receptor blockers in the treatment of patients with arterial hypertension, coronary heart disease and heart failure, as well as recommendations for urgent and emergency care for cardiac patients in the context of the COVID-19 pandemic.

Angiotensin-Receptor Blockers (ARBs) and risk of Alzheimer´s Disease: A meta-analysis

2020 ◽  
Vol 15 ◽  
Author(s):  
Teodoro J. Oscanoa ◽  
José Amado ◽  
Xavier Vidal ◽  
Roman Romero-Ortuno
Keyword(s):  
Observational Studies ◽  
Angiotensin Receptor Blockers ◽  
Meta Analysis ◽  
Cognitive Disorders ◽  
Hypotensive Effect ◽  
Angiotensin Receptor ◽  
Inclusion Criteria ◽  
Case Control Studies ◽  
Antihypertensive Medications ◽  
Receptor Blockers

Background: Antihypertensive medications may reduce the incidence of cognitive disorders. This may be due to reasons beyond their pure hypotensive effect. This study aimed to systematically review the association between the use of Angiotensin-Receptor Blockers (ARBs)and the incidence of Alzheimer’s Disease (AD). Methods: We systematically searched studies reporting the association between ARB use and incidence of AD. Results: Ten studies (1 RCT, 2 case-control studies and 7 cohort studies) met the inclusion criteria. When all observational studies (9) were analyzed, ARB use was associated with a reduced risk of incident AD (HR 0.72, 95% CI: 0.58-0.88, p<0.001). In the only RCT, the decrease in the incidence of AD was also significant (HR= 0.31,95% CI:0.14-0.68). Conclusion: ARB use may reduce the risk of incident AD. This association does not imply causation and further research is required to clarify potential mechanisms.

scholarly journals Protocol for the Controlled evaLuation of Angiotensin Receptor blockers for COVID-19 respIraTorY disease (CLARITY): a randomised controlled trial

Trials ◽  
2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Carinna Hockham ◽  
Sradha Kotwal ◽  
Arlen Wilcox ◽  
Abhinav Bassi ◽  
James McGree ◽  
...  
Keyword(s):  
Angiotensin Ii ◽  
Randomised Controlled Trial ◽  
Sample Size ◽  
Angiotensin Receptor Blockers ◽  
Controlled Trial ◽  
Ordinal Scale ◽  
Angiotensin Receptor ◽  
Receptor Blockers ◽  
Membrane Bound ◽  
Randomised Controlled

Abstract Background SARS-CoV-2 binds to membrane-bound angiotensin-converting enzyme 2 (ACE2) which may result in downregulation of membrane-bound ACE2. ACE2 is a key regulator of the renin-angiotensin system (RAS) and is responsible for degrading angiotensin II and thereby counteracting its pro-inflammatory, pro-fibrotic effects mediated through the angiotensin II type 1 receptor (AT1R). As AT1R is directly blocked by angiotensin receptor blockers (ARBs), these agents may offer a safe, low-cost solution for reducing COVID-19 respiratory outcomes. Methods and discussion CLARITY is a pragmatic, adaptive, two-arm, multi-centre, comparative effectiveness phase III randomised controlled trial that examines whether ARBs reduce COVID-19 severity among high-risk patients. Recruiting in India and Australia, the trial will compare treatment with a maximum tolerated daily dose of an ARB to standard of care. Treatment allocation is blinded in India but open-label in Australia due to interruptions to placebo supply in the latter. The primary endpoint is a 7-point ordinal scale of clinical states, ranging from no limitation of activities (category 1) to death (category 7), assessed on day 14. Secondary outcomes include the 7-point scale assessed at day 28 and 28- and 90-day mortality. The design adapts the sample size based on accumulating data via frequent interim analyses and the use of predictive probability to determine whether the current sample size is sufficient or continuing accrual would be futile. The trial commenced recruitment on 18 August 2020. Trial registration ClinicalTrials.gov, NCT04394117. Registered on 19 May 2020. Clinical Trial Registry of India: CTRI/2020/07/026831)

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