Pharmacotherapeutic agents for the management of COVID-19 patients with preexisting cardiovascular disease

Abstract

Introduction The coronavirus disease 2019 (COVID-19) pandemic is the largest public health challenge of the twenty-first century. While COVID-19 primarily affects the respiratory system, manifesting as interstitial pneumonitis and severe acute respiratory distress syndrome (ARDS), it also has implications for the cardiovascular system. Moreover, those admitted to hospital with severe COVID-19 are more likely to have cardiovascular comorbidities such as hypertension and diabetes mellitus. The underlying pathophysiology of why COVID-19 onset can further decline cardiac pathologies as well as trigger acute onset of new cardiac complications is not yet well understood. Areas covered In this review, the authors extensively review literature focused on the current understanding and approaches of managing patients who have underlying cardiovascular diseases and concomitant COVID-19 infection. Furthermore, the authors explore the possible cardiovascular implications of the suggested COVID-19 therapeutic agents that are used to treat this lethal disease. Expert opinion Current evidence is evolving around the many trialed pharmacotherapeutic considerations for the management of coronavirus disease 2019 (COVID-19) in patients with cardiovascular disease. While we await such data, clinicians should advocate for careful consideration of all concomitant medications for those presenting with COVID-19 on a patient-by-patient basis.

The Influence of SARS-CoV-2 Infection on Lipid Metabolism—The Potential Use of Lipid-Lowering Agents in COVID-19 Management

“…Their mechanism of action inhibits circulating PCSK9 protein, thereby blocking degradation of the LDL receptor (LDLR), increasing its expression on the surface of hepatocytes and the uptake of LDL into the liver [ 90 ]. This injectable lipid-lowering therapy is dedicated especially for those with familial hypercholesterolemia (FH) [ 90 , 91 , 92 ]. FH is a genetic condition that causes significant increases in serum cholesterol and LDL-C levels.…”

“…FH is a genetic condition that causes significant increases in serum cholesterol and LDL-C levels. FH begins at a noticeably young age and responds poorly to oral therapy, and therefore represents an increased cardiovascular risk for individuals affected [ 92 ].…”

“…PCSK9 inhibitors are believed to exhibit anti-inflammatory properties thanks to down-regulating LDL-C levels. Hyperinflammation is one of COVID-19 characteristics and muting the excessive immune response may be beneficial in disease management [ 92 ]. COVID-19 patients that previously presented with cardiovascular disease were at a greater risk of a more severe course of the disease, COVID-19-induced cardiac injury, and therefore death [ 92 ].…”

Evaluation of CRP, D-Dimer of clinical significance in Iraqi patients with COVID-19 and associated comorbidities

“…Mendelian randomization study found a higher level of ACE-2 receptors to be causally associated to diabetes; this may predispose patients with diabetes to SARS-CoV-2 infection [15]. Furin is a type 1 membranebound protease that is overexpressed in diabetics [16]. This proprotein convertase helps the virus get inside the host cell by reducing SARS-reliance CoV-2's on human proteases.…”

“…As a result, a dysregulated immune response characterized by increased ACE-2receptors and furin expression may result in greater lung inflammation and reduced insulin levels. For diabetic individuals, the virus's easy entrance creates a life-threatening situation [15,16]. Furthermore, decreased T-cell activity and higher levels of interleukin-6 (IL-6) play a key role in the development of COVID-19 illness in diabetics [18].…”