2019 CORONAVIRUS: What are the implications for cardiology?

COVID-19 in the heart and the lungs: could we “Notch” the inflammatory storm?

“…It has been proposed that patients receiving ARBs have higher susceptibility to COVID-19 [15] and, as a consequence, hypertensive or patients with heart failure should switch from ARBs to other drugs. This way of thinking, however, is not supported by any evidence [16]. Actually, there are caveats here: (1) ACE2 expression is reduced in hypertension models; (2) there is no evidence of increased ACE2 expression with ARBs in the lung; (3) hypertension and its treatment with ARBs did not affect previous coronavirus infections [16].…”

“…This way of thinking, however, is not supported by any evidence [16]. Actually, there are caveats here: (1) ACE2 expression is reduced in hypertension models; (2) there is no evidence of increased ACE2 expression with ARBs in the lung; (3) hypertension and its treatment with ARBs did not affect previous coronavirus infections [16].…”

“…A second report from the same period of time on 138 patients hospitalised at Zhongnan Hospital of Wuhan University shows that 26% of the patients required cardiologic intensive care. Among these patients, 16.7% developed arrhythmias and 7.2% experienced an acute coronary syndrome in addition to other complications [51]. Furthermore, patients diagnosed with pneumonia due to SARS-CoV-2 infection showed an increase in high-sensitivity cardiac troponin I levels, suggesting myocardial injury [23].…”

Cardiovascular complications in COVID-19: A systematic review and meta-analysis

“…However, not all cardiovascular manifestations of COVID-19 are clearly defined by published studies and it is also not clear if these conditions are directly caused by COVID-19 or are just unspecific complications. 3 There is a need to understand the interplay between COVID-19 and its cardiovascular manifestations to assist in the optimum management of patients. In this context, we conducted a systematic meta-analysis to attempt to address the following questions: (i) what are the cardiovascular complications associated with COVID-19?…”

In reply—Angiotensin-Converting Enzyme 2 and the Resolution of Inflammation: In Support of Continuation of Prescribed Angiotensin-Converting Enzyme Inhibitors and Angiotensin Receptor Blockers

“…Moreover, it has been previously reported that ACE2 expression is reduced in HTN animal models and historically HTN has not affected outcomes of other coronavirus infections. 7 Most concerning is the fact that Marin 6 claimed that many patients from South America, Central America, and Spain have abruptly interrupted their treatments with ACEIs or ARBs over these hypothetical concerns, which may be as dangerous to patients as COVID-19 itself.…”