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Renin-angiotensin-aldosterone system inhibitors are safe during COVID-19 infection, whereas their discontinuation in patients with cardiovascular disease is associated with increased all-cause mortality.
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Reveals that withdrawing renin-angiotensin-aldosterone inhibitors increases mortality in COVID-19 patients, indicating these medications should be maintained.
This editorial comment refers to the article ''Impact of renin-angiotensin-aldosterone inhibitors withdrawal on mortality in COVID-19 patients'' by Caro-Codón et al., published in this issue of the Revista Portuguesa de Cardiologia. 1 The anchor-point of SARS-CoV-2 in human cell membranes, specifically in the respiratory epithelium, is a protein called angiotensin-converting enzyme-2 (ACE-2).Once attached to this protein, internalization vesicles are formed and the virus enters the cytoplasm.The consequence of SARS-CoV-2 virus binding to ACE-2 and the resulting internalization of these molecules is a decrease in ACE-2 on the epithelial cells' surface.1---3 Contrary to angiotensin-converting enzyme-1 (ACE-1), which promotes the conversion of angiotensin-I into angiotensin-II, thus increasing serum concentrations of the latter, ACE-2 reduces angiotensin-II levels by transforming it into angiotensin.1---7 Angiotensin-II has deleterious effects which include vasoconstriction, sodium retention, cell proliferation, apoptosis, fibrosis, and inflammation.Angiotensin 1---7 has diametrically opposed protective effects.2.3
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Silva‐Cardoso et al. (2022) conducted an editorial in COVID-19 infection in patients with cardiovascular disease. Renin-angiotensin-aldosterone system inhibitors (RAASi) continuation vs. RAASi discontinuation was evaluated on All-cause mortality. Renin-angiotensin-aldosterone system inhibitors are safe during COVID-19 infection, whereas their discontinuation in patients with cardiovascular disease is associated with increased all-cause mortality.
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