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COVID-19: Case fatality and ACE2 inhibitors treatment concerns in patients with comorbidities

Rokhsareh Aghili1, Maryam Honardoost1,2, Mohammad E Khamseh1

  • 1Endocrine Research Center, Institute of Endocrinology and Metabolism, Iran University of Medical Sciences, Tehran, Iran.

Medical Journal of the Islamic Republic of Iran
|January 13, 2021
PubMed

Insights

The COVID-19 pandemic disproportionately affects patients with comorbidities. Medications targeting the renin-angiotensin-aldosterone system may cause complications, necessitating alternative treatments for these vulnerable individuals.

Area of Science:

  • Virology
  • Cardiovascular Medicine
  • Endocrinology

Background:

  • The COVID-19 pandemic, caused by an RNA virus, presents high mortality rates in patients with underlying health conditions.
  • The virus utilizes its spike protein to bind with the Angiotensin-converting enzyme 2 (ACE2) receptor on host cells for entry.
  • Comorbidities like diabetes and hypertension are prevalent among severe COVID-19 cases.

Purpose of the Study:

  • To highlight the risks associated with renin-angiotensin-aldosterone system (RAAS) medications in COVID-19 patients with comorbidities.
  • To advocate for the exploration and utilization of alternative therapeutic strategies for this high-risk population.

Main Methods:

  • Review of current literature on COVID-19 pathophysiology and its interaction with the renin-angiotensin-aldosterone system.
  • Analysis of the role of ACE2 as a viral entry receptor.
  • Examination of potential complications of RAAS-modulating drugs in the context of COVID-19 infection.

Main Results:

  • Angiotensin-converting enzyme 2 (ACE2) is identified as the primary host cell receptor for the SARS-CoV-2 virus.
  • Medications that modulate the renin-angiotensin-aldosterone system may exacerbate COVID-19 severity or complications in patients with diabetes and hypertension.
  • The interaction between viral entry mechanisms and host physiological systems presents significant clinical challenges.

Conclusions:

  • COVID-19 patients with diabetes and hypertension treated with RAAS-acting medications face increased risks.
  • Alternative treatment modalities are crucial for managing COVID-19 in patients with significant comorbidities.
  • Further research into safe and effective alternative therapies is warranted to mitigate COVID-19 mortality in vulnerable populations.

Keywords:
ACE2 inhibitorsAssociated comorbiditiesCOVID-19TreatmentType 2 diabetes

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