COVID‐19: The heart of the issue

• DOI: 10.1111/jocs.14684
• Publication Date: 2020-06-16T08:59:27Z
• Authors: Beth Woodward; Muhammed Kermali
• Keywords: Angiotensin-converting enzyme 2; Coronavirus

We read with great interest the review by Khan et al1 who discussed emerging role of cardiovascular disease and progression novel coronavirus 19 (COVID-19). As part their review, authors a broad range effects being observed during after infection in this disease. commend conclusions that appropriate triage risk stratification is essential patients (CVD) COVID-19. encourage need for further evidence regarding mechanisms CVD particularly use therapeutics. This particular importance given global concern about renin-angiotensin-aldosterone system (RAAS) inhibitors severe acute respiratory distress syndrome-coronavirus-2 (SARS-CoV-2). SARS-CoV-2 utilizes angiotensin-converting enzyme 2 (ACE2) cell membrane protein on lung alveolar epithelial cells to enter host cells.1 ACE2 key RAAS cascade so highlighting understanding was justified. contributing increased severity COVID-19, most commonly hypertension, logical hypothesis due mode action. However, it currently unclear whether virus's interaction causes dysregulation or interference downstream effectors. Early observational studies concluded may not be associated more COVID-19 progression. One retrospective multicentre study 1128 participants (188 inhibitor) suggested hospitalized pre-existing had better outcomes compared non-RAAS inhibitor use.2 supports continuing if already prescribed, but recognizes significant confounding variables methodology.2 Discontinuing these medications potentially put at greater complications, directly indirectly from period blood pressure instability attenuating known cardio- renal-protective effects.3 Furthermore, highlighted complications myocardial injury have also been peri- postinfection SARS-CoV-2, even without CVD.1 Given are yet elucidated likely multifactorial, notion. support conclusion made there limited recommend should discontinued prophylactically confirmed cases.3, 4 It pivotal preclinical carried out understand emphasize elucidate infection. Robust collaborative human needed apply meaningful way, where major variables, such as advancing age, can accounted for. The declare no conflict interests.